Provider Demographics
NPI:1720622624
Name:FAAN YEEN SIDOR, PSY.D. LTD
Entity Type:Organization
Organization Name:FAAN YEEN SIDOR, PSY.D. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAAN YEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-431-1722
Mailing Address - Street 1:755 GREENVIEW PL
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3222
Mailing Address - Country:US
Mailing Address - Phone:847-431-1722
Mailing Address - Fax:
Practice Address - Street 1:175 OLDE HALF DAY RD STE 100-7
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3062
Practice Address - Country:US
Practice Address - Phone:847-431-1722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty