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General NPI Number Information
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NPI Number | 1407075823
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Entity Type | Individual
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Provider Name | CHARLES VINCENT A ONG YIU PT
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 6120 W OGDEN AVE
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City | CICERO
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State | IL
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Zip | 60804-3743
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Country | US
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Telephone | 708-863-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 6005 DEMPSTER ST
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City | MORTON GROVE
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State | IL
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Zip | 60053
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Country | US
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Telephone | 847-470-1844
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070014428
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License Number State | IL
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