Provider Demographics
NPI:1649864828
Name:CHA, MARK JUNGJUN (NP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:JUNGJUN
Last Name:CHA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1616 S SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5041
Mailing Address - Country:US
Mailing Address - Phone:773-517-6498
Mailing Address - Fax:
Practice Address - Street 1:7786 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1583
Practice Address - Country:US
Practice Address - Phone:708-425-3085
Practice Address - Fax:708-425-3089
Is Sole Proprietor?:No
Enumeration Date:2021-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.021866363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner