Healthcare Provider Details

I. General information

NPI: 1396713590
Provider Name (Legal Business Name): JEFFREY CHUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BARRINGTON RD RADIOLOGY DEPARTMENT
HOFFMAN ESTATES IL
60194-1019
US

IV. Provider business mailing address

PO BOX 1690
WOODSTOCK IL
60098-1690
US

V. Phone/Fax

Practice location:
  • Phone: 847-490-6989
  • Fax:
Mailing address:
  • Phone: 815-337-1466
  • Fax: 815-337-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036089631
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number036-089631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: