MEDICARE: MONA WUCHEN YANG

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DE60516648	WA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	021.002699	IL

General Provider Information

NPI Number	:	1346537131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONA WUCHEN YANG

Provider Business Mailing Address
First Line	:	2537 N GREENVIEW AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2028
Country	:	US
Telephone Number	:	206-519-4074
Fax Number	:

Provider Business Practice Location Address
First Line	:	2537 N GREENVIEW AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2028
Country	:	US
Telephone Number	:	206-519-4074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	10/25/2019

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