Provider Demographics
NPI:1184851842
Name:LYUSHKOVA, YANA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:YANA
Middle Name:A
Last Name:LYUSHKOVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N DEARBORN ST
Mailing Address - Street 2:#2405
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2756
Mailing Address - Country:US
Mailing Address - Phone:847-529-4499
Mailing Address - Fax:
Practice Address - Street 1:1130 N DEARBORN ST
Practice Address - Street 2:#2405
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2756
Practice Address - Country:US
Practice Address - Phone:847-529-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190280121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice