Healthcare Provider Details

I. General information

NPI: 1871119495
Provider Name (Legal Business Name): TERESA YANG KUHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA HANNAN YANG

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST STE 5-704
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST STE 5-704
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0061
  • Fax: 312-695-9013
Mailing address:
  • Phone: 312-695-0061
  • Fax: 312-695-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209023685
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: