Provider Demographics
NPI:1356568745
Name:C. J. YOON, M.D., PC
Entity type:Organization
Organization Name:C. J. YOON, M.D., PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:C.J.
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:219-738-5775
Mailing Address - Street 1:833 W LINCOLN HWY
Mailing Address - Street 2:SUITE 200W
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1683
Mailing Address - Country:US
Mailing Address - Phone:219-934-5300
Mailing Address - Fax:219-934-5389
Practice Address - Street 1:8701 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7035
Practice Address - Country:US
Practice Address - Phone:219-738-5775
Practice Address - Fax:219-736-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100340330Medicaid