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General NPI Number Information
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NPI Number | 1679680490
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Entity Type | Individual
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Provider Name | SUSIE CHUNG D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 4432 OAKTON ST SUITE B
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City | SKOKIE
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State | IL
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Zip | 60076-3259
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Country | US
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Telephone | 847-942-3887
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Fax | 847-677-7454
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Provider Business Mailing Address
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Address Line | 4432 OAKTON ST SUITE B
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City | SKOKIE
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State | IL
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Zip | 60076-3259
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Country | US
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Telephone | 847-942-3887
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Fax | 847-677-7454
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 19025528
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License Number State | IL
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