Provider Demographics
NPI:1316958002
Name:CHEN, CHUNG KUANG (MD)
Entity type:Individual
Prefix:
First Name:CHUNG
Middle Name:KUANG
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 TIMBER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1456
Mailing Address - Country:US
Mailing Address - Phone:630-747-6353
Mailing Address - Fax:
Practice Address - Street 1:3624 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-2216
Practice Address - Country:US
Practice Address - Phone:630-747-6353
Practice Address - Fax:773-486-1057
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360511392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051139Medicaid
IL002201201OtherBCBS
IL002201201OtherBCBS