Provider Demographics
NPI:1275547226
Name:YONAN, KENNETH PERA (DDSMS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PERA
Last Name:YONAN
Suffix:
Gender:M
Credentials:DDSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2927
Mailing Address - Country:US
Mailing Address - Phone:847-724-6550
Mailing Address - Fax:
Practice Address - Street 1:1008 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2927
Practice Address - Country:US
Practice Address - Phone:847-724-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics