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General NPI Number Information
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NPI Number | 1255692026
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Entity Type | Organization
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Legal Business Name | SOYOUNG KWON DPM PC
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 9820 MILWAUKEE AVE C-D
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City | DES PLAINES
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State | IL
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Zip | 60016-1805
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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 | PODIATRIST
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Name | DR. SOYOUNG C KWON
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Credential | DPM
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Telephone | 630-290-8797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016.005474
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License Number State | IL
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