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NPI Code Detail

MEDICARE: DR. GARY KEVIN YONG O.D.

MEDICARE: DR. GARY KEVIN YONG O.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
1152W00000XOptometrist046.010266IL

General Provider Information

NPI Number : 1992936454
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY KEVIN YONG O.D.
Provider Business Mailing Address
First Line : 366 DIXIE HWY
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1758
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 366 DIXIE HWY
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1758
Country : US
Telephone Number : 708-754-0080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2009
Last Update Date : 07/31/2009

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