=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467820001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3P4CARE (IL) LLC AVONDALE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2015
-----------------------------------------------------
Last Update Date | 11/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3502 N KEDZIE AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60618-5622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-654-1888
-----------------------------------------------------
Fax | 773-754-7412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3502 N KEDZIE AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60618-5622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-654-1888
-----------------------------------------------------
Fax | 773-754-7412
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. AUGUSTINE CHU-KWAN WONG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 773-654-1888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 036.094438
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------