Provider Demographics
NPI:1851608764
Name:YONG CHUL CHUN, M.D., S.C.
Entity type:Organization
Organization Name:YONG CHUL CHUN, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YONG
Authorized Official - Middle Name:CHUL
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-539-5333
Mailing Address - Street 1:3703 TORREY PINES PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3129
Mailing Address - Country:US
Mailing Address - Phone:773-539-5333
Mailing Address - Fax:
Practice Address - Street 1:3755 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5712
Practice Address - Country:US
Practice Address - Phone:773-539-5333
Practice Address - Fax:773-539-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053060261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053060Medicaid
ILC41379Medicare UPIN
IL036053060Medicaid