Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036-046399 | IL |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 036046399 | IL |
NPI | 1063484798 |
---|---|
Provider Name | Dr. Stephen Yeh JR. |
First Address | Chicago, IL 60623 |
Second Address | Chicago, IL 60623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 17/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036046399 | (05) | IL |
21608740 | BC BS OF ILLINOIS (01) | IL |
D13270 | (02) |