Provider Demographics
NPI:1598323107
Name:AKKASH, YAZAN (DMD)
Entity Type:Individual
Prefix:
First Name:YAZAN
Middle Name:
Last Name:AKKASH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S LAFLIN ST APT 714
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4654
Mailing Address - Country:US
Mailing Address - Phone:203-300-7852
Mailing Address - Fax:
Practice Address - Street 1:1111 S LAFLIN ST APT 714
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4654
Practice Address - Country:US
Practice Address - Phone:203-300-7852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist