Provider Demographics
NPI:1073704573
Name:CHOI, SUNG YONG
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:YONG
Last Name:CHOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CHICAGO AVE
Mailing Address - Street 2:A
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2375
Mailing Address - Country:US
Mailing Address - Phone:847-560-0095
Mailing Address - Fax:
Practice Address - Street 1:825 CHICAGO AVE
Practice Address - Street 2:A
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2375
Practice Address - Country:US
Practice Address - Phone:847-560-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000576171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist