Provider Demographics
NPI:1821062944
Name:RA-HURKA, YONGSUN (MD)
Entity Type:Individual
Prefix:
First Name:YONGSUN
Middle Name:
Last Name:RA-HURKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:(321 N LAGRANGE RD., LAGRANGE, IL. 60526)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-485-1020
Mailing Address - Fax:708-485-1173
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(321 N LAGRANGE RD., LAGRANGE, IL. 60526)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-485-1020
Practice Address - Fax:708-485-1173
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36106096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36106096Medicaid
IL36106096Medicaid
IL202377Medicare ID - Type Unspecified