Provider Demographics
NPI:1326380379
Name:KWON, SUNG JIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:JIN
Last Name:KWON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4215 KIRCHOFF RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-2005
Mailing Address - Country:US
Mailing Address - Phone:847-348-7789
Mailing Address - Fax:847-789-7202
Practice Address - Street 1:4215 KIRCHOFF RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-2005
Practice Address - Country:US
Practice Address - Phone:847-348-7789
Practice Address - Fax:847-789-7202
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-17
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL016.005532213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery