Provider Demographics
NPI:1346329729
Name:SOUTHWEST DERMATOLOGY, PC
Entity Type:Organization
Organization Name:SOUTHWEST DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHEUK
Authorized Official - Middle Name:W
Authorized Official - Last Name:YUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-460-7890
Mailing Address - Street 1:15300 WEST AVE
Mailing Address - Street 2:SUITE 120 SOUTH
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4600
Mailing Address - Country:US
Mailing Address - Phone:708-460-7890
Mailing Address - Fax:708-460-1207
Practice Address - Street 1:15300 WEST AVE
Practice Address - Street 2:SUITE 120 SOUTH
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4600
Practice Address - Country:US
Practice Address - Phone:708-460-7890
Practice Address - Fax:708-460-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K07403Medicare ID - Type Unspecified
ILL99550Medicare ID - Type Unspecified
P60539Medicare UPIN
ILD14504Medicare UPIN
H88109Medicare UPIN
ILL99553Medicare ID - Type Unspecified
ILQ00619Medicare UPIN
ILK16089Medicare ID - Type Unspecified
ILK02052Medicare ID - Type Unspecified