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General NPI Number Information
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NPI Number | 1497964936
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Entity Type | Organization
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Legal Business Name | J. JACQUELINE CHUN, D.D.S.
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4801 W PETERSON AVE SUITE 211
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City | CHICAGO
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State | IL
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Zip | 60646-5713
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Country | US
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Telephone | 773-205-0097
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 W PETERSON AVE SUITE 211
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City | CHICAGO
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State | IL
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Zip | 60646-5713
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Country | US
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Telephone | 773-205-0097
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEE JACQUELINE CHUN
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Credential | D.D.S.
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Telephone | 773-205-0097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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