Healthcare Provider Details

I. General information

NPI: 1407792138
Provider Name (Legal Business Name): SE HEE KANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 CRAWFORD AVE STE 212
EVANSTON IL
60201-4959
US

IV. Provider business mailing address

1112 CASTILIAN CT APT 206
GLENVIEW IL
60025-2460
US

V. Phone/Fax

Practice location:
  • Phone: 224-529-4282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149025120
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: