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General NPI Number Information
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NPI Number | 1770677304
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Entity Type | Individual
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Provider Name | HANNAH HEWON YASUNAGA DDS
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 1221 E CONDIT ST
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City | DECATUR
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State | IL
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Zip | 62521-1405
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Country | US
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Telephone | 217-423-9930
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Fax |
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Provider Business Mailing Address
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Address Line | 1709 E MUMFORD DR
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City | URBANA
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State | IL
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Zip | 61802-8605
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Country | US
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Telephone | 217-402-3240
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Fax |
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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 | 019.027593
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License Number State | IL
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