1144244872 NPI number — DR. KRISTINA EUNJOO CHUNG-HELLINGA D.C.

Table of content: DR. KRISTINA EUNJOO CHUNG-HELLINGA D.C. (NPI 1144244872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144244872 NPI number — DR. KRISTINA EUNJOO CHUNG-HELLINGA D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUNG-HELLINGA
Provider First Name:
KRISTINA
Provider Middle Name:
EUNJOO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHUNG
Provider Other First Name:
EUNJOO
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144244872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 CANADA OAKS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTO DE CAZA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92679-4937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-330-3018
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4753 N BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60640-5266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-271-8284
Provider Business Practice Location Address Fax Number:
773-271-9139
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038008534 , 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)

  • Identifier: 0001632897 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 364427599 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 364427599 . This is a "HUMANA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com