Provider Demographics
NPI:1750352753
Name:HUNG, SAM T (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:T
Last Name:HUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:(300 N YORK RD, ELMHURST, ILLINOIS 60126)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-327-7030
Mailing Address - Fax:630-833-8834
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(300 N YORK RD, ELMHURST, ILLINOIS 60126)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-327-7030
Practice Address - Fax:630-833-8834
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361070006207R00000X
IL036107806208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H73338Medicare UPIN