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NPI Code Detail

MEDICARE: DAVID TAEWOONG CHUNG MD

MEDICARE: DAVID TAEWOONG CHUNG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036103251IL

General Provider Information

NPI Number : 1417914557
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID TAEWOONG CHUNG MD
Provider Business Mailing Address
First Line : 1300 N MARKET ST
Second Line :
City : SPARTA
State : IL
Zip : 62286-1048
Country : US
Telephone Number : 618-443-3084
Fax Number : 618-443-2956
Provider Business Practice Location Address
First Line : 1300 N MARKET ST
Second Line :
City : SPARTA
State : IL
Zip : 62286-1048
Country : US
Telephone Number : 618-443-4138
Fax Number : 618-443-2956
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2006
Last Update Date : 08/08/2023

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Directions to “ DAVID TAEWOONG CHUNG MD” Practice Location

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