Healthcare Provider Details

I. General information

NPI: 1497698310
Provider Name (Legal Business Name): CHAEYOUNG MO M.D.
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 WEST DEMPSTER STREET, 8 SOUTH
PARK RIDGE IL
60068
US

IV. Provider business mailing address

1775 WEST DEMPSTER STREET, 8 SOUTH
PARK RIDGE IL
60068
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-2210
  • Fax: 847-723-8285
Mailing address:
  • Phone: 847-723-2210
  • Fax: 847-723-8285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.087188
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: