MEDICARE: GRACE YOSHIBA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036.159466	IL
2	2080P0206X	Pediatric Gastroenterology Physician	036.159466	IL

General Provider Information

NPI Number	:	1912566084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE YOSHIBA MD

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST STE 710
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3863
Country	:	US
Telephone Number	:	312-942-3034
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST STE 710
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3863
Country	:	US
Telephone Number	:	312-942-3034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	06/01/2026

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