1811150964 NPI number — JOHN P. HUNG, M.D.,S.C.

Table of content: (NPI 1811150964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811150964 NPI number — JOHN P. HUNG, M.D.,S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN P. HUNG, M.D.,S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811150964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 HERITAGE PLZ
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
BOURBONNAIS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60914-1369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-932-1516
Provider Business Mailing Address Fax Number:
815-932-9412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 HERITAGE PLZ
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
BOURBONNAIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60914-1369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-932-1516
Provider Business Practice Location Address Fax Number:
815-932-9412
Provider Enumeration Date:
07/09/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MERTEN
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
815-932-1516

Provider Taxonomy Codes

  • Taxonomy code: 207YX0602X , with the licence number:  036052305 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)