Provider Demographics
NPI:1093087363
Name:KWON, SOYOUNG CHRISTINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:SOYOUNG
Middle Name:CHRISTINE
Last Name:KWON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:SOYOUNG
Other - Middle Name:CHRISTINE
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:8239 N NEW ENGLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2610
Mailing Address - Country:US
Mailing Address - Phone:630-290-8797
Mailing Address - Fax:
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:#515
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:847-213-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005474213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist