Provider Demographics
NPI:1972602860
Name:SONG, YOUNG DON (DMD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:DON
Last Name:SONG
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 1:775 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:847-540-6598
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:847-540-6598
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice