Provider Demographics
NPI:1619024163
Name:SONE-JUNG, SE SOOK (MD)
Entity Type:Individual
Prefix:DR
First Name:SE
Middle Name:SOOK
Last Name:SONE-JUNG
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 1:4909 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-3161
Mailing Address - Country:US
Mailing Address - Phone:773-921-8100
Mailing Address - Fax:773-921-4428
Practice Address - Street 1:4909 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3161
Practice Address - Country:US
Practice Address - Phone:773-921-8100
Practice Address - Fax:773-921-4428
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-056692208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics