Provider Demographics
NPI:1972037281
Name:ALEXIS B YOUN DENTAL LTD
Entity Type:Organization
Organization Name:ALEXIS B YOUN DENTAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DR.ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-322-6882
Mailing Address - Street 1:1844 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:312-322-6882
Mailing Address - Fax:
Practice Address - Street 1:1844 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:312-322-6882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty