Provider Demographics
NPI:1548641608
Name:KWEON, SUNG HEE (FNP)
Entity type:Individual
Prefix:
First Name:SUNG
Middle Name:HEE
Last Name:KWEON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E NORTHWEST HWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2290
Mailing Address - Country:US
Mailing Address - Phone:773-930-4538
Mailing Address - Fax:
Practice Address - Street 1:380 E NORTHWEST HWY
Practice Address - Street 2:SUITE 240
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2290
Practice Address - Country:US
Practice Address - Phone:773-930-4538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011619363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.011619OtherADVANCED PRACTICE NURSE LICENSE
IL309.008327OtherCONTROLLED SUBSTANCE LICENSE
IL041.317209OtherPROFESSIONAL LICENSE