Healthcare Provider Details

I. General information

NPI: 1982306908
Provider Name (Legal Business Name): BROOKE LY YANG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 06/11/2023
Certification Date: 06/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

298 RANDALL RD
GENEVA IL
60134-4203
US

V. Phone/Fax

Practice location:
  • Phone: 630-208-3000
  • Fax:
Mailing address:
  • Phone: 630-208-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125082517
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: