Healthcare Provider Details

I. General information

NPI: 1104838440
Provider Name (Legal Business Name): SUNG A CHEON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BELVIDERE RD
WAUKEGAN IL
60085-6165
US

IV. Provider business mailing address

761 COVENTRY DR
LAKE FOREST IL
60045-2785
US

V. Phone/Fax

Practice location:
  • Phone: 847-377-8779
  • Fax: 847-984-5619
Mailing address:
  • Phone: 847-615-0692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036057505
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number036057505
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: