Provider Demographics
NPI:1952322158
Name:YOUNG SONG CORP.
Entity Type:Organization
Organization Name:YOUNG SONG CORP.
Other - Org Name:A HEALTHY SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:D
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-540-6597
Mailing Address - Street 1:775 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2348
Mailing Address - Country:US
Mailing Address - Phone:847-540-6597
Mailing Address - Fax:
Practice Address - Street 1:775 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2348
Practice Address - Country:US
Practice Address - Phone:847-540-6597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty