Provider Demographics
NPI:1982797452
Name:HING CHEONG FUNG
Entity Type:Organization
Organization Name:HING CHEONG FUNG
Other - Org Name:DIVISION CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HING
Authorized Official - Middle Name:CHEONG
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST IN CHARGE
Authorized Official - Phone:773-235-0259
Mailing Address - Street 1:3624 WEST DIVISION STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3624 WEST DIVISION STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651
Practice Address - Country:US
Practice Address - Phone:773-235-0259
Practice Address - Fax:773-486-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054013387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL1259580001Medicare NSC