Provider Demographics
NPI:1982213245
Name:YANG, CHUL HO (DDS)
Entity Type:Individual
Prefix:
First Name:CHUL HO
Middle Name:
Last Name:YANG
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 1:5871 GATEWAY EAST DR
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-4423
Mailing Address - Country:US
Mailing Address - Phone:608-692-7504
Mailing Address - Fax:
Practice Address - Street 1:9940 PENDLETON PIKE UNIT B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-2823
Practice Address - Country:US
Practice Address - Phone:317-541-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013437A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice