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General NPI Number Information
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NPI Number | 1093087363
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Entity Type | Individual
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Provider Name | SOYOUNG CHRISTINE KWON D.P.M
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Gender | Female
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 5140 N CALIFORNIA AVE #515
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City | CHICAGO
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State | IL
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Zip | 60625-3645
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Country | US
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Telephone | 847-213-9003
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Fax |
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Provider Business Mailing Address
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Address Line | 8239 N NEW ENGLAND AVE
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City | NILES
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State | IL
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Zip | 60714-2610
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Country | US
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Telephone | 630-290-8797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016.005474
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License Number State | IL
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