Provider Demographics
NPI:1376653352
Name:YUNG, LAURENCE (DO)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:
Last Name:YUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 COMMERCE LANE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1677
Mailing Address - Country:US
Mailing Address - Phone:618-651-9777
Mailing Address - Fax:618-651-3419
Practice Address - Street 1:2504 COMMERCE LANE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1677
Practice Address - Country:US
Practice Address - Phone:618-651-9777
Practice Address - Fax:618-651-3419
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118642207P00000X, 207Q00000X
MI5101013067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1376653352Medicaid
IL036118642-3Medicaid
IL1811135882OtherBCBS
H04325Medicare UPIN
MO1376653352Medicaid