Healthcare Provider Details

I. General information

NPI: 1497757306
Provider Name (Legal Business Name): CHUNG Z MOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W LAWRENCE AVE
CHICAGO IL
60625-5627
US

IV. Provider business mailing address

3535 W LAWRENCE AVE
CHICAGO IL
60625-5627
US

V. Phone/Fax

Practice location:
  • Phone: 773-539-5455
  • Fax: 312-326-3007
Mailing address:
  • Phone: 773-539-5455
  • Fax: 312-326-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036058992
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: