Provider Demographics
NPI:1255692026
Name:SOYOUNG KWON DPM PC
Entity type:Organization
Organization Name:SOYOUNG KWON DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SOYOUNG
Authorized Official - Middle Name:C
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-290-8797
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 1:9820 MILWAUKEE AVE
Practice Address - Street 2:C-D
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1805
Practice Address - Country:US
Practice Address - Phone:847-213-9003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005474213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty