MEDICARE: KELLY GA EUN CHUNG FNP-BC

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	363LF0000X	Family Nurse Practitioner	209033856	IL

General Provider Information

NPI Number	:	1649112863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY GA EUN CHUNG FNP-BC

Provider Business Mailing Address
First Line	:	1515 LEE ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1518
Country	:	US
Telephone Number	:	844-599-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 LEE ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1518
Country	:	US
Telephone Number	:	844-599-3700
Fax Number	:

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

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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