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General NPI Number Information
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NPI Number | 1619260247
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Entity Type | Organization
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Legal Business Name | SOUTHWEST DERMATOLOGY
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 1870 SILVER CROSS BOULEVARD SUITE 250
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City | NEW LENOX
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State | IL
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Zip | 60451
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Country | US
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Telephone | 815-463-8989
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Fax | 815-463-8948
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Provider Business Mailing Address
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Address Line | 1870 SILVER CROSS BOULEVARD SUITE 250
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City | NEW LENOX
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State | IL
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Zip | 60451
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Country | US
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Telephone | 815-463-8989
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Fax | 815-463-8948
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Authorized Official
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Title or Position | M.D./
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Name | CHEUK W YUNG
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Credential | M.D.
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Telephone | 815-463-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 36111373
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 36116569
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 36059742
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License Number State | IL
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