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General NPI Number Information
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NPI Number | 1942731757
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Entity Type | Individual
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Provider Name | PENUEL CHUN
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Gender | Male
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 355 RIDGE AVE
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City | EVANSTON
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State | IL
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Zip | 60202-3328
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Country | US
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Telephone | 262-292-3151
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Fax |
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Provider Business Mailing Address
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Address Line | S. 1ST AVENUE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 260-460-0514
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 125071391
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 036.163946
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License Number State | IL
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