Provider Demographics
NPI:1295844934
Name:YOON, WOOSUK STEVE (MD)
Entity Type:Individual
Prefix:
First Name:WOOSUK
Middle Name:STEVE
Last Name:YOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6785 WEAVER RD
Mailing Address - Street 2:STE D
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8055
Mailing Address - Country:US
Mailing Address - Phone:815-227-0077
Mailing Address - Fax:815-227-5886
Practice Address - Street 1:4777 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2273
Practice Address - Country:US
Practice Address - Phone:815-227-0077
Practice Address - Fax:815-227-5886
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-102401207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204470Medicare ID - Type Unspecified
ILH00491Medicare UPIN