Provider Demographics
NPI:1760104129
Name:Y CHAE DMD LLC
Entity Type:Organization
Organization Name:Y CHAE DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:YOUNGSOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-830-2502
Mailing Address - Street 1:2206 SUSSEX WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1360
Mailing Address - Country:US
Mailing Address - Phone:716-830-2502
Mailing Address - Fax:
Practice Address - Street 1:1667 CROFTON CTR STE 7A
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1303
Practice Address - Country:US
Practice Address - Phone:443-292-8009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty