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General NPI Number Information
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NPI Number | 1801119987
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Entity Type | Organization
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Legal Business Name | MIKYUNG YUN OD PC
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 03/11/2011
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Provider Practice Location Address
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Address Line | 150 SMITH RD
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City | ST CHARLES
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State | IL
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Zip | 60174-5203
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Country | US
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Telephone | 630-513-9566
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Fax | 630-513-9786
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Provider Business Mailing Address
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Address Line | 150 SMITH RD
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City | ST CHARLES
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State | IL
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Zip | 60174-5203
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKYUNG BAKER
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Credential |
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Telephone | 630-606-1618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046-009764
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License Number State | IL
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