Healthcare Provider Details

I. General information

NPI: 1477468577
Provider Name (Legal Business Name): QIAN CHENG VICTOR SUN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S DESPLAINES ST
CHICAGO IL
60607-4420
US

IV. Provider business mailing address

5841 S MARYLAND AVE RM G603
CHICAGO IL
60637-1443
US

V. Phone/Fax

Practice location:
  • Phone: 312-989-8873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number061114347
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: