MEDICARE: DR. YASMIN VANESSA KOCMOND D.D.S

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	1223G0001X	General Practice Dentistry	019029429	IL

General Provider Information

NPI Number	:	1811335730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YASMIN VANESSA KOCMOND D.D.S

Provider Business Mailing Address
First Line	:	769 N KENILWORTH AVE
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-3850
Country	:	US
Telephone Number	:	847-702-9577
Fax Number	:

Provider Business Practice Location Address
First Line	:	2024 OAKTON ST
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1958
Country	:	US
Telephone Number	:	847-292-6540
Fax Number	:	847-292-0771

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

Provider Enumeration Date	:	06/13/2013
Last Update Date	:	01/16/2025

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