Healthcare Provider Details

I. General information

NPI: 1013602697
Provider Name (Legal Business Name): SHAHEN YASHPAL H.BSC, MSC., DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EXECUTIVE CT # 102
SOUTH BARRINGTON IL
60010-9507
US

IV. Provider business mailing address

30 E ELM ST APT 10D
CHICAGO IL
60611-1057
US

V. Phone/Fax

Practice location:
  • Phone: 847-277-9911
  • Fax:
Mailing address:
  • Phone: 646-371-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number021.003542
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.035000
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: