Basic Information
| Provider Information | |||||||||
| NPI: | 1114094042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOO | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | JUNG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 W ERIE ST | ||||||||
| Address2: | #806 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606546456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127876825 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 OGDEN AVE | ||||||||
| Address2: | RUSH COPLEY MEDICAL CENTER | ||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605047222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309786250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 04/28/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | A90539 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 036108007 | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 04515143 | 01 | BCBS PROVIDER | OTHER | 00A905390 | 05 | CA | MEDICAID |