Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 125.068194 | IL |
NPI | 1003269846 |
---|---|
Provider Name | Suyeun Ban |
First Address | Chicago, IL 60608-1732 |
Second Address | Chicago, IL 60608-1732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2016 |
Last Update Date | 17/07/2016 |