MEDICARE: DR. WAI SANG YAM DDS

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	1223G0001X	General Practice Dentistry		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386702199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAI SANG YAM DDS

Provider Business Mailing Address
First Line	:	716 LAPORTE AVE
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-2022
Country	:	US
Telephone Number	:	847-256-0938
Fax Number	:

Provider Business Practice Location Address
First Line	:	2254 W FOSTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1860
Country	:	US
Telephone Number	:	773-561-7389
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/09/2007

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