Provider Demographics
NPI:1275744070
Name:YONGSMITH, NILLAWAN S (MD)
Entity Type:Individual
Prefix:
First Name:NILLAWAN
Middle Name:S
Last Name:YONGSMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8522CARRAIGEGREENSDR.
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5310
Mailing Address - Country:US
Mailing Address - Phone:630-935-7893
Mailing Address - Fax:630-985-7893
Practice Address - Street 1:8522CARRIAGEGREENSDR.
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5310
Practice Address - Country:US
Practice Address - Phone:630-985-7893
Practice Address - Fax:630-985-7893
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine