Provider Demographics
NPI:1942795430
Name:YENKONG, RICHARD YULLAMBO (APN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:YULLAMBO
Last Name:YENKONG
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 JERICHO RD APT A5
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-5621
Mailing Address - Country:US
Mailing Address - Phone:630-803-0551
Mailing Address - Fax:
Practice Address - Street 1:2270 JERICHO RD APT A5
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-5621
Practice Address - Country:US
Practice Address - Phone:630-803-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily