MEDICARE: DR. ALEXIS BUNHONG YOUN DDS

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	122300000X	Dentist	019028790	IL
2	1223G0001X	General Practice Dentistry	2901020268	MI

General Provider Information

NPI Number	:	1447551155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS BUNHONG YOUN DDS

Provider Business Mailing Address
First Line	:	2 E ERIE ST
Second Line	:	APT 3901
City	:	CHICAGO
State	:	IL
Zip	:	60611-2724
Country	:	US
Telephone Number	:	734-604-1271
Fax Number	:	312-322-6881

Provider Business Practice Location Address
First Line	:	1844 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622
Country	:	US
Telephone Number	:	312-322-6882
Fax Number	:	312-322-6881

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

Provider Enumeration Date	:	11/11/2010
Last Update Date	:	10/12/2016

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