Healthcare Provider Details

I. General information

NPI: 1003182973
Provider Name (Legal Business Name): YI-LOONG COLIN WOON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

835 S WOLCOTT AVE M/C 844
CHICAGO IL
60612-3748
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 312-996-9858
  • Fax: 312-996-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number287503
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: