Basic Information
| Provider Information | |||||||||
| NPI: | 1962897181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HWANG | ||||||||
| FirstName: | SOOK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 SPRING DR | ||||||||
| Address2: | |||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157448554 | ||||||||
| FaxNumber: | 6304951770 | ||||||||
| Practice Location | |||||||||
| Address1: | 2685 JOLLY RD | ||||||||
| Address2: | |||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488643553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345947931 | ||||||||
| FaxNumber: | 7344640335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2015 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 4301502319 | MI | Y | Allopathic & Osteopathic Physicians | Dermatology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.