Healthcare Provider Details

I. General information

NPI: 1902324858
Provider Name (Legal Business Name): SIU YEUNG DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 810
CHICAGO IL
60611-8700
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 810
CHICAGO IL
60611-8700
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-8811
  • Fax:
Mailing address:
  • Phone: 312-926-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070024101
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: