Provider Demographics
NPI:1851533178
Name:YU, SONGCHIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SONGCHIN
Middle Name:
Last Name:YU
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 1:150 S. KENNEDY DRIVE SUITE 23A
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-2094
Mailing Address - Country:US
Mailing Address - Phone:847-551-1199
Mailing Address - Fax:847-783-5282
Practice Address - Street 1:150 S KENNEDY DR
Practice Address - Street 2:23A
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-2091
Practice Address - Country:US
Practice Address - Phone:847-551-1199
Practice Address - Fax:847-783-5282
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist