MEDICARE: YOUNG ESTHETICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	019.029678	IL

General Provider Information

NPI Number	:	1215337779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG ESTHETICS

Provider Business Mailing Address
First Line	:	3142 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3142 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3306
Country	:	US
Telephone Number	:	773-940-1967
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. YOUNG SHIN
Credential	:
Telephone Number	:	773-940-1967

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	09/02/2014

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Directions to “YOUNG ESTHETICS ” Practice Location

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