Provider Demographics
NPI:1346537131
Name:YANG, MONA WUCHEN
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:WUCHEN
Last Name:YANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WUCHEN
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2537 N GREENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2028
Mailing Address - Country:US
Mailing Address - Phone:206-519-4074
Mailing Address - Fax:
Practice Address - Street 1:2537 N GREENVIEW AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2028
Practice Address - Country:US
Practice Address - Phone:206-519-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE605166481223X0400X
390200000X
IL021.0026991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program