Provider Demographics
NPI:1386715142
Name:HUNG, JOHN P (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:HUNG
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 1:19 HERITAGE PLAZA
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1369
Mailing Address - Country:US
Mailing Address - Phone:815-932-1516
Mailing Address - Fax:815-932-9412
Practice Address - Street 1:19 HERITAGE PLAZA
Practice Address - Street 2:SUITE 210
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1369
Practice Address - Country:US
Practice Address - Phone:815-932-1516
Practice Address - Fax:815-932-9412
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052305207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4600170OtherBCBS
IL041128967Medicaid
C43221Medicare UPIN
218090Medicare ID - Type Unspecified