MEDICARE: HAE JUNG HUH M.D.

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
1	208D00000X	General Practice Physician	36-056959	IL

General Provider Information

NPI Number	:	1538410915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAE JUNG HUH M.D.

Provider Business Mailing Address
First Line	:	5432 N VIRGINIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3916
Country	:	US
Telephone Number	:	773-784-4330
Fax Number	:	773-784-4350

Provider Business Practice Location Address
First Line	:	5432 N VIRGINIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3916
Country	:	US
Telephone Number	:	777-844-3303
Fax Number	:	773-784-4350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	09/26/2012

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