Provider Demographics
NPI:1417224387
Name:DR. KANA YAJIMA DDS
Entity Type:Organization
Organization Name:DR. KANA YAJIMA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAJIMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-255-5550
Mailing Address - Street 1:411 W. WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-255-5550
Mailing Address - Fax:847-259-3945
Practice Address - Street 1:411 W. WALNUT ST.
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:847-255-5550
Practice Address - Fax:847-259-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190243431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty