Provider Demographics
NPI:1174624241
Name:KUNG, AMIINAH Y (MD)
Entity type:Individual
Prefix:
First Name:AMIINAH
Middle Name:Y
Last Name:KUNG
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 1:1315 MACOM DR STE 203
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9361
Mailing Address - Country:US
Mailing Address - Phone:630-357-1884
Mailing Address - Fax:630-357-9304
Practice Address - Street 1:1315 MACOM DR STE 203
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564
Practice Address - Country:US
Practice Address - Phone:630-357-1884
Practice Address - Fax:630-357-9304
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48943208000000X
IL036128593207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I61185Medicare UPIN