Provider Demographics
NPI:1124133459
Name:BAKER, MIKYUNG YUN (OD)
Entity type:Individual
Prefix:DR
First Name:MIKYUNG
Middle Name:YUN
Last Name:BAKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MIKYUNG
Other - Middle Name:
Other - Last Name:YUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:150 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 SMITH RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5203
Practice Address - Country:US
Practice Address - Phone:630-513-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist