Healthcare Provider Details

I. General information

NPI: 1699762757
Provider Name (Legal Business Name): GARY YONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 W SAINT CHARLES RD
LOMBARD IL
60148-2231
US

IV. Provider business mailing address

126 W SAINT CHARLES RD
LOMBARD IL
60148-2231
US

V. Phone/Fax

Practice location:
  • Phone: 630-629-0017
  • Fax: 630-629-1506
Mailing address:
  • Phone: 630-629-0017
  • Fax: 630-629-1506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: