Provider Demographics
NPI:1528491321
Name:SOUTHWEST DERMATOLOGY, PC
Entity type:Organization
Organization Name:SOUTHWEST DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHEUK
Authorized Official - Middle Name:W
Authorized Official - Last Name:YUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-586-4506
Mailing Address - Street 1:7123 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2203
Mailing Address - Country:US
Mailing Address - Phone:773-586-4506
Mailing Address - Fax:
Practice Address - Street 1:7123 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2203
Practice Address - Country:US
Practice Address - Phone:773-586-4506
Practice Address - Fax:773-586-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060008763207N00000X, 207ND0101X, 207NI0002X, 207NS0135X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty