Healthcare Provider Details

I. General information

NPI: 1063733541
Provider Name (Legal Business Name): CHUNG (JEREMY) WONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHUN YU WONG M.D.

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE SUITE 325
AURORA IL
60504-5894
US

IV. Provider business mailing address

1009 WINDEMERE LN
AURORA IL
60504-8966
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4850
  • Fax: 630-978-6865
Mailing address:
  • Phone: 708-703-2912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125057745
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: