Provider Demographics
NPI:1790367845
Name:JUNG, SEUNGMIN (DPT)
Entity Type:Individual
Prefix:
First Name:SEUNGMIN
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:JUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1801 W BELLE PLAINE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2493
Mailing Address - Country:US
Mailing Address - Phone:773-477-7599
Mailing Address - Fax:773-477-7601
Practice Address - Street 1:1801 W BELLE PLAINE AVE STE 102
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2493
Practice Address - Country:US
Practice Address - Phone:773-477-7599
Practice Address - Fax:773-477-7601
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070025676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist