Provider Demographics
NPI:1609341387
Name:UY, BENEDICTO JR (LAC)
Entity Type:Individual
Prefix:
First Name:BENEDICTO
Middle Name:
Last Name:UY
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 W ARGYLE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4057
Mailing Address - Country:US
Mailing Address - Phone:847-387-2940
Mailing Address - Fax:
Practice Address - Street 1:17 N WABASH AVE STE 470
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4818
Practice Address - Country:US
Practice Address - Phone:312-508-3955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001501171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist