Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 36072370 | IL |
NPI | 1457328536 |
---|---|
Provider Name | Youngran Chung |
First Address | Chicago, IL 60611-2605 |
Second Address | Winfield, IL 60190 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 09/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36072370 | (05) | IL |
E56127 | (02) |