Healthcare Provider Details

I. General information

NPI: 1053064352
Provider Name (Legal Business Name): SOOKH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 S NAPERVILLE RD STE 103
WHEATON IL
60189-5846
US

IV. Provider business mailing address

4755 KARNS AVE
LISLE IL
60532-1666
US

V. Phone/Fax

Practice location:
  • Phone: 630-635-0577
  • Fax:
Mailing address:
  • Phone: 224-522-6618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DHRUVIL PANDYA
Title or Position: PRESIDENT
Credential: MD
Phone: 224-522-6618