Provider Demographics
NPI:1710011598
Name:BYUN, YOUNG (MD,SC)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:
Last Name:BYUN
Suffix:
Gender:M
Credentials:MD,SC
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:BYUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1775 WALTERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4591
Mailing Address - Country:US
Mailing Address - Phone:874-513-6899
Mailing Address - Fax:
Practice Address - Street 1:1775 WALTERS AVE
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4591
Practice Address - Country:US
Practice Address - Phone:874-513-6899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG 90855Medicare UPIN
IL540210Medicare ID - Type UnspecifiedMEDICARE POVIDER #