Healthcare Provider Details

I. General information

NPI: 1891601852
Provider Name (Legal Business Name): MY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W HIGGINS RD STE 635
HOFFMAN ESTATES IL
60169-2046
US

IV. Provider business mailing address

2500 W HIGGINS RD STE 635
HOFFMAN ESTATES IL
60169-2046
US

V. Phone/Fax

Practice location:
  • Phone: 847-885-8530
  • Fax:
Mailing address:
  • Phone: 847-885-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: YONGHWI MOON
Title or Position: OWNER / DENTIST
Credential: DDS
Phone: 585-683-0248