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General NPI Number Information
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NPI Number | 1144858788
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Entity Type | Individual
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Provider Name | JAEWON JUNG MD
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Gender | Female
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 1725 W HARRISON ST STE 10
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City | CHICAGO
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State | IL
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Zip | 60612-3849
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Country | US
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Telephone | 312-563-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 1725 W HARRISON ST STE 10
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City | CHICAGO
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State | IL
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Zip | 60612-3849
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Country | US
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Telephone | 312-563-3700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081H0002X
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Taxonomy Name | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 036172072
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License Number State | IL
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