Provider Demographics
NPI:1063733541
Name:WONG, CHUNG (JEREMY) (MD)
Entity type:Individual
Prefix:DR
First Name:CHUNG (JEREMY)
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHUN YU
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1009 WINDEMERE LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8966
Mailing Address - Country:US
Mailing Address - Phone:708-703-2912
Mailing Address - Fax:
Practice Address - Street 1:2020 OGDEN AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5894
Practice Address - Country:US
Practice Address - Phone:630-978-4850
Practice Address - Fax:630-978-6865
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125057745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine