Provider Demographics
NPI:1386118594
Name:JUNG, INHO SAMUEL
Entity type:Individual
Prefix:
First Name:INHO
Middle Name:SAMUEL
Last Name:JUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3073
Mailing Address - Country:US
Mailing Address - Phone:847-912-5212
Mailing Address - Fax:
Practice Address - Street 1:8125 RIVER DR
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2642
Practice Address - Country:US
Practice Address - Phone:847-470-1720
Practice Address - Fax:847-470-1723
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.024149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist