Provider Demographics
NPI:1851380943
Name:JUNG, DAVID D (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:JUNG
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 1:225 EAST CHICAGO AVE, BOX 152
Mailing Address - Street 2:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2605
Mailing Address - Country:US
Mailing Address - Phone:312-227-7413
Mailing Address - Fax:312-227-9525
Practice Address - Street 1:225 EAST CHICAGO AVE, BOX 152
Practice Address - Street 2:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2605
Practice Address - Country:US
Practice Address - Phone:312-227-7413
Practice Address - Fax:312-227-9525
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2013-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103932208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103932Medicaid
ILH51753Medicare UPIN
ILL98148Medicare PIN