Provider Demographics
NPI:1699762757
Name:YONG, GARY (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:YONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W SAINT CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2231
Mailing Address - Country:US
Mailing Address - Phone:630-629-0017
Mailing Address - Fax:630-629-1506
Practice Address - Street 1:126 W SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2231
Practice Address - Country:US
Practice Address - Phone:630-629-0017
Practice Address - Fax:630-629-1506
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0220131106OtherBCBS
ILL18951Medicare PIN
C42361Medicare UPIN