MEDICARE: DR. JULIA LAI-TEH YEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036072682	IL

General Provider Information

NPI Number	:	1912124538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA LAI-TEH YEN M.D.

Provider Business Mailing Address
First Line	:	1274 TOWER RD
Second Line	:
City	:	WINNETKA
State	:	IL
Zip	:	60093-1638
Country	:	US
Telephone Number	:	847-446-3853
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 N MICHIGAN AVE STE 1910
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3178
Country	:	US
Telephone Number	:	312-951-8833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	12/13/2020

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