Healthcare Provider Details

I. General information

NPI: 1447299763
Provider Name (Legal Business Name): KENNETH YOKOSAWA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVENUE SUITE 330
AURORA IL
60504
US

IV. Provider business mailing address

2020 OGDEN AVE STE 330
AURORA IL
60504-5897
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4850
  • Fax: 630-978-6865
Mailing address:
  • Phone: 630-978-4850
  • Fax: 630-978-6865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036134722
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number036134722
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number036134722
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036134722
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: