Healthcare Provider Details

I. General information

NPI: 1629879671
Provider Name (Legal Business Name): SHIN YOUNG G YU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST STE 3E
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

160 N MORGAN ST UNIT 803
CHICAGO IL
60607-5215
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6966
  • Fax:
Mailing address:
  • Phone: 224-522-4813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number125.085803
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: