Provider Demographics
NPI:1841202827
Name:SUNG, TAE HYUN (MD)
Entity Type:Individual
Prefix:
First Name:TAE
Middle Name:HYUN
Last Name:SUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 WEST GRAND AVENUE
Mailing Address - Street 2:ROOM 105
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707
Mailing Address - Country:US
Mailing Address - Phone:773-637-4454
Mailing Address - Fax:773-637-2560
Practice Address - Street 1:7035 WEST GRAND AVENUE
Practice Address - Street 2:ROOM 105
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707
Practice Address - Country:US
Practice Address - Phone:773-637-4454
Practice Address - Fax:773-637-2560
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3653502208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C42278Medicare UPIN
IL488680Medicare ID - Type Unspecified