NPIMap

Organization Active NPI

Southwest Dermatology

  • Dermatology Physician
  • New Lenox, IL
National Provider Identifier
1619260247
Registry record updated Jun 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
36059742 Issued in IL
Legal business name
SOUTHWEST DERMATOLOGY
Practice address
1870 Silver Cross Boulevard
Suite 250
New Lenox, IL 60451
Phone
(815) 463-8989
Fax
(815) 463-8948
NPI assigned
May 16, 2011
Organization subpart
Yes
Parent organization
SOUTHWEST DERMATOLOGYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cheuk W Yung, M.D.
Title
M.D./
Phone
(815) 463-8989

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 36059742 IL Primary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 36111373 IL
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 36116569 IL

Addresses

Primary practice location

1870 Silver Cross Boulevard
Suite 250
New Lenox, IL 60451

Mailing address

1870 Silver Cross Boulevard
Suite 250
New Lenox, IL 60451
Phone (815) 463-8989

National Provider Directory

National Provider Directory
Tax ID family
Southwest Dermatology P2 organizations share this tax ID, including this one
Part of
Southwest Dermatology P

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308614400000",
    "number": "1619260247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1870 SILVER CROSS BOULEVARD",
            "address_2": "SUITE 250",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "60451",
            "telephone_number": "815-463-8989",
            "fax_number": "815-463-8948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1870 SILVER CROSS BOULEVARD",
            "address_2": "SUITE 250",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "60451",
            "telephone_number": "815-463-8989",
            "fax_number": "815-463-8948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST DERMATOLOGY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHWEST DERMATOLOGY",
        "enumeration_date": "2011-05-16",
        "last_updated": "2011-06-21",
        "status": "A",
        "authorized_official_last_name": "YUNG",
        "authorized_official_first_name": "CHEUK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "M.D./",
        "authorized_official_telephone_number": "815-463-8989",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "36059742",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "36111373",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "36116569",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Lenox, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.