Provider Demographics
NPI:1053404343
Name:WONG, SZE KIN (MD)
Entity type:Individual
Prefix:DR
First Name:SZE
Middle Name:KIN
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2323 S. WENTWORTH AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:312-842-0100
Mailing Address - Fax:312-842-4967
Practice Address - Street 1:2323 S WENTWORTH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4615
Practice Address - Country:US
Practice Address - Phone:312-842-0100
Practice Address - Fax:312-842-4967
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE19052Medicare UPIN