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General NPI Number Information
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NPI Number | 1568613297
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Entity Type | Individual
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Provider Name | YONG SUK CHANG DDS
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Gender | Male
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 712 FRONT ST EASY DENTAL CARE LLC
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City | MCHENRY
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State | IL
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Zip | 60050-5530
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Country | US
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Telephone | 815-363-1577
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Fax | 815-363-1677
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Provider Business Mailing Address
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Address Line | 712 FRONT ST EASY DENTAL CARE LLC
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City | MCHENRY
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State | IL
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Zip | 60050-5530
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Country | US
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Telephone | 815-363-1577
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Fax | 815-363-1677
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | IL 019-023530
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License Number State | IL
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