Healthcare Provider Details

I. General information

NPI: 1316432420
Provider Name (Legal Business Name): YANG ZHOU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2018
Last Update Date: 06/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 SYCAMORE RD
DEKALB IL
60115-2046
US

IV. Provider business mailing address

3417 BRADBURY CIR
AURORA IL
60504-6890
US

V. Phone/Fax

Practice location:
  • Phone: 630-849-9476
  • Fax:
Mailing address:
  • Phone: 630-849-9476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019031679
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: