Provider Demographics
NPI:1568613297
Name:CHANG, YONG SUK (DDS)
Entity Type:Individual
Prefix:MR
First Name:YONG
Middle Name:SUK
Last Name:CHANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 FRONT ST
Mailing Address - Street 2:EASY DENTAL CARE LLC
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5530
Mailing Address - Country:US
Mailing Address - Phone:815-363-1577
Mailing Address - Fax:815-363-1677
Practice Address - Street 1:712 FRONT ST
Practice Address - Street 2:EASY DENTAL CARE LLC
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5530
Practice Address - Country:US
Practice Address - Phone:815-363-1577
Practice Address - Fax:815-363-1677
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL 019-023530122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist