Basic Information
| Provider Information | |||||||||
| NPI: | 1528491321 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST DERMATOLOGY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7123 W ARCHER AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606382203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735864506 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7123 W ARCHER AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606382203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735864506 | ||||||||
| FaxNumber: | 7735865044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2013 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | YUNG | ||||||||
| AuthorizedOfficialFirstName: | CHEUK | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7735864506 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 060008763 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | 207ND0101X | 060008763 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207NI0002X | 060008763 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Clinical & Laboratory Dermatological Immunology | 207NS0135X | 060008763 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | 207ND0900X | 060008763 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology |
No ID Information.