Healthcare Provider Details

I. General information

NPI: 1992946511
Provider Name (Legal Business Name): KYUNG WOON YOO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST DEPT OF RADIOLOGY
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

9655 WOODS DR #411
SKOKIE IL
60077-4418
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-3825
  • Fax:
Mailing address:
  • Phone: 847-682-8259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.118206
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: