Healthcare Provider Details

I. General information

NPI: 1386715142
Provider Name (Legal Business Name): JOHN P HUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 HERITAGE PLAZA SUITE 210
BOURBONNAIS IL
60914-1369
US

IV. Provider business mailing address

19 HERITAGE PLAZA SUITE 210
BOURBONNAIS IL
60914-1369
US

V. Phone/Fax

Practice location:
  • Phone: 815-932-1516
  • Fax: 815-932-9412
Mailing address:
  • Phone: 815-932-1516
  • Fax: 815-932-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number036052305
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: