Provider Demographics
NPI:1134178056
Name:YI, JONG-YOON (MD)
Entity type:Individual
Prefix:DR
First Name:JONG-YOON
Middle Name:
Last Name:YI
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 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-6549
Mailing Address - Country:US
Mailing Address - Phone:630-469-2000
Mailing Address - Fax:
Practice Address - Street 1:1890 SILVER CROSS BLVD STE 240
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9528
Practice Address - Country:US
Practice Address - Phone:815-740-1900
Practice Address - Fax:815-485-4469
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088548207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088548Medicaid
ILL63804Medicare PIN
ILL69432Medicare PIN
IL036088548Medicaid
ILK18698Medicare PIN
ILL69416Medicare PIN