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General NPI Number Information
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NPI Number | 1639489057
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Entity Type | Organization
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Legal Business Name | NAPERVILLE MEDICAL GROUP CORPORATION
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 454 W BOUGHTON RD STE C
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1378
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Country | US
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Telephone | 312-823-3469
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Fax | 630-759-4505
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Provider Business Mailing Address
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Address Line | 1308 LITTLE BERRY CT
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City | NAPERVILLE
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State | IL
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Zip | 60565-1751
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Country | US
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Telephone | 630-416-3191
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Fax | 630-416-3191
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SIJUN YANG YANG SR.
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Credential | M.D.
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Telephone | 630-416-3191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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