Provider Demographics
NPI:1790736833
Name:CHUNG, HYUNJA (MD)
Entity Type:Individual
Prefix:MRS
First Name:HYUNJA
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 N LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1787
Mailing Address - Country:US
Mailing Address - Phone:773-588-6370
Mailing Address - Fax:773-588-6370
Practice Address - Street 1:5430 N LOWELL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1787
Practice Address - Country:US
Practice Address - Phone:773-588-6370
Practice Address - Fax:773-588-6370
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108175Medicaid
IL036108175Medicaid
ILIL3214Medicare PIN