Provider Demographics
NPI:1538150644
Name:CHUNG, DIANA H (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:H
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 COMMERCE DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1546
Mailing Address - Country:US
Mailing Address - Phone:847-698-0600
Mailing Address - Fax:847-698-0601
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:BLDG C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-792-5133
Practice Address - Fax:773-792-5013
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360978742085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097874Medicaid
ILP00222220OtherRAILROAD MEDICARE
ILP00222220OtherRAILROAD MEDICARE
ILK18108Medicare ID - Type Unspecified