Healthcare Provider Details

I. General information

NPI: 1174624241
Provider Name (Legal Business Name): AMIINAH Y KUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 MACOM DR STE 203
NAPERVILLE IL
60564
US

IV. Provider business mailing address

1315 MACOM DR STE 203
NAPERVILLE IL
60564-9361
US

V. Phone/Fax

Practice location:
  • Phone: 630-357-1884
  • Fax: 630-357-9304
Mailing address:
  • Phone: 630-357-1884
  • Fax: 630-357-9304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036128593
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number48943
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: