Basic Information
| Provider Information | |||||||||
| NPI: | 1922073501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIM | ||||||||
| FirstName: | CHUNG | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10350 HALIGUS RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | HUNTLEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601429545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153386600 | ||||||||
| FaxNumber: | 8478027203 | ||||||||
| Practice Location | |||||||||
| Address1: | 10350 HALIGUS RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | HUNTLEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153386600 | ||||||||
| FaxNumber: | 8478027203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 10/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 036083588 | IL | N | Other Service Providers | Specialist | 207Q00000X | 036083588 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5632092 | 01 | IL | BCBS | OTHER | K04173 | 01 | IL | MEDICARE PIN | OTHER | 036083588 | 01 | IL | STATE LICENSE | OTHER |