MEDICARE: YUMMY DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	021002143	IL

General Provider Information

NPI Number	:	1013147024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YUMMY DENTAL

Provider Business Mailing Address
First Line	:	3500 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1104
Country	:	US
Telephone Number	:	312-773-7994
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1104
Country	:	US
Telephone Number	:	312-773-7994
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OWNER
Name	:	DR. GRACE YUM
Credential	:
Telephone Number	:	312-988-9855

Provider Enumeration Date	:	07/24/2009
Last Update Date	:	07/24/2009

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Directions to “YUMMY DENTAL ” Practice Location

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