Healthcare Provider Details

I. General information

NPI: 1194165118
Provider Name (Legal Business Name): YESENIA BAHENA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 E 95TH ST
CHICAGO IL
60617-4804
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 773-768-7700
  • Fax:
Mailing address:
  • Phone: 305-628-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36141312
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: