Provider Demographics
NPI:1881762581
Name:LU, JEFF YASIN (DDS)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:YASIN
Last Name:LU
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 1:211 EAST OHIO STREET
Mailing Address - Street 2:#2419
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:630-728-2129
Mailing Address - Fax:
Practice Address - Street 1:115 WEST PEACE ROAD
Practice Address - Street 2:PRAIRIE VIEW DENTAL
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178
Practice Address - Country:US
Practice Address - Phone:815-895-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist