Healthcare Provider Details

I. General information

NPI: 1548930779
Provider Name (Legal Business Name): YICTORY HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2021
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PARK PL STE 2
BOURBONNAIS IL
60914-1883
US

IV. Provider business mailing address

1106 MIDWEST CLUB PKWY
OAK BROOK IL
60523-2535
US

V. Phone/Fax

Practice location:
  • Phone: 708-288-9536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MING XU
Title or Position: CEO
Credential: MD
Phone: 708-288-9536