Healthcare Provider Details

I. General information

NPI: 1306330378
Provider Name (Legal Business Name): SUEMIN JASMINE YOON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WESTMORELAND RD # LEVEL3
LAKE FOREST IL
60045-1658
US

IV. Provider business mailing address

1000 N WESTMORELAND RD
LAKE FOREST IL
60045-1658
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-7658
  • Fax: 847-535-7150
Mailing address:
  • Phone: 847-535-7658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036.160886
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number036160886
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: