Healthcare Provider Details

I. General information

NPI: 1053246314
Provider Name (Legal Business Name): ASIM DHUNGANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 RIDGE AVE
EVANSTON IL
60202-3328
US

IV. Provider business mailing address

734 W SHERIDAN RD APT 909
CHICAGO IL
60613-5364
US

V. Phone/Fax

Practice location:
  • Phone: 847-316-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125088419
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: