Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036112910 | IL |
NPI | 1023072378 |
---|---|
Provider Name | Miyoung Won |
First Address | Chicago, IL 60674-0018 |
Second Address | Blue Island, IL 60406-2426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 22/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036112910 | (05) | IL |
I48050 | (02) | IL |
P00271315 | RAILROAD MEDICARE (01) | IL |