Individual
SIN LEI PUI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1620 W HARRISON ST, CHICAGO, IL 60612-3801
(312) 942-5000
Mailing address
150 FOREST AVE UNIT 1304, OAK PARK, IL 60301-1456
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
125.088355
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/16/2025
Last updated
06/18/2026
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