Provider Demographics
NPI:1023380300
Name:YUI Y CHAN, M.D.S.C.
Entity Type:Organization
Organization Name:YUI Y CHAN, M.D.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YUI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-842-9888
Mailing Address - Street 1:2171 S CHINA PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1536
Mailing Address - Country:US
Mailing Address - Phone:312-842-9888
Mailing Address - Fax:312-842-9882
Practice Address - Street 1:2171 S CHINA PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1536
Practice Address - Country:US
Practice Address - Phone:312-842-9888
Practice Address - Fax:312-842-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36045083261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12352Medicare UPIN