Provider Demographics
NPI:1689662066
Name:WEN, DENNIS YK (MD)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:YK
Last Name:WEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 N AIRLITE ST STE 220
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4995
Mailing Address - Country:US
Mailing Address - Phone:847-695-6611
Mailing Address - Fax:847-695-8069
Practice Address - Street 1:87 N AIRLITE ST STE 220
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4995
Practice Address - Country:US
Practice Address - Phone:847-695-6611
Practice Address - Fax:847-695-8069
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-095129207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21602371OtherBCBS
IL036095129Medicaid
IL036095129Medicaid
357910Medicare ID - Type Unspecified