Provider Demographics
NPI:1962653568
Name:YANG, SIJUN (MD)
Entity Type:Individual
Prefix:
First Name:SIJUN
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:454 W BOUGHTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1378
Mailing Address - Country:US
Mailing Address - Phone:312-823-3469
Mailing Address - Fax:630-778-8572
Practice Address - Street 1:454 W BOUGHTON RD STE C
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1378
Practice Address - Country:US
Practice Address - Phone:630-778-8571
Practice Address - Fax:630-778-8572
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-122231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4661001Medicare PIN