Basic Information
| Provider Information | |||||||||
| NPI: | 1255310629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUNG | ||||||||
| FirstName: | HYUNCHUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 W. PARK ST. | ||||||||
| Address2: | BWPC | ||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618012500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173836792 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1802 S. MATTIS AVENUE | ||||||||
| Address2: | ORTHOPEDICS | ||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173833355 | ||||||||
| FaxNumber: | 2173834459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 05/22/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 036110555 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 036110555 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207Q00000X | 036110555 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036110555 | 01 | IL | BC OF IL | OTHER | 036110555 | 05 | IL | MEDICAID |