Healthcare Provider Details

I. General information

NPI: 1467402412
Provider Name (Legal Business Name): NEUNGJA CHUNG PH.D, M.S.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MENDOTA COMMUNITY HOSPITAL 1315 MEMORIAL DRIVE
MENDOTA IL
61342
US

IV. Provider business mailing address

689 CHIPPEWA DR
NAPERVILLE IL
60563-1385
US

V. Phone/Fax

Practice location:
  • Phone: 815-713-0468
  • Fax:
Mailing address:
  • Phone: 630-355-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: