Healthcare Provider Details

I. General information

NPI: 1518235043
Provider Name (Legal Business Name): SY HEALTH REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9865 W ROOSEVELT RD 105
WESTCHESTER IL
60154-2767
US

IV. Provider business mailing address

9865 W ROOSEVELT RD 105
WESTCHESTER IL
60154-2767
US

V. Phone/Fax

Practice location:
  • Phone: 708-344-1422
  • Fax: 708-344-1481
Mailing address:
  • Phone: 708-344-1422
  • Fax: 708-344-1481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number036099392
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036099392
License Number StateIL

VIII. Authorized Official

Name: DR. SUNTO YEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-344-1422