Organization
SOUTHWEST DERMATOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHEUK W YUNG M.D. (CEO/OWNER)
(773) 586-4506
Entity
Organization
Contact information
Practice address
7123 W ARCHER AVE, CHICAGO, IL 60638-2203
(773) 586-4506
(773) 586-5044
Mailing address
7123 W ARCHER AVE, CHICAGO, IL 60638-2203
(773) 586-4506
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
060008763
IL
207ND0101X
MOHS-Micrographic Surgery Physician
060008763
IL
207ND0900X
Dermatopathology Physician
Primary
060008763
IL
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
060008763
IL
207NS0135X
Procedural Dermatology Physician
060008763
IL
Other
Enumeration date
08/15/2013
Last updated
12/12/2013
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