Provider Demographics
NPI:1538410915
Name:HUH, HAE JUNG (MD)
Entity type:Individual
Prefix:
First Name:HAE JUNG
Middle Name:
Last Name:HUH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5432 N VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3916
Mailing Address - Country:US
Mailing Address - Phone:773-784-4330
Mailing Address - Fax:773-784-4350
Practice Address - Street 1:5432 N VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3916
Practice Address - Country:US
Practice Address - Phone:777-844-3303
Practice Address - Fax:773-784-4350
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-056959208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice