Healthcare Provider Details

I. General information

NPI: 1104826254
Provider Name (Legal Business Name): IL Y YOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S CALIFORNIA AVE
CHICAGO IL
60608-1732
US

IV. Provider business mailing address

415 E NORTH WATER ST #807
CHICAGO IL
60611-5594
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-6843
  • Fax:
Mailing address:
  • Phone: 312-527-4434
  • Fax: 312-527-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-052573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: