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General NPI Number Information
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NPI Number | 1912124538
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Entity Type | Individual
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Provider Name | JULIA LAI-TEH YEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 12/13/2020
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Provider Practice Location Address
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Address Line | 625 N MICHIGAN AVE STE 1910
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City | CHICAGO
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State | IL
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Zip | 60611-3178
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Country | US
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Telephone | 312-951-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 1274 TOWER RD
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City | WINNETKA
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State | IL
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Zip | 60093-1638
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Country | US
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Telephone | 847-446-3853
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036072682
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License Number State | IL
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