Provider Demographics
NPI:1366589871
Name:YANG, INCHUN (DDS)
Entity type:Individual
Prefix:
First Name:INCHUN
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4608
Mailing Address - Country:US
Mailing Address - Phone:847-486-0575
Mailing Address - Fax:847-486-0578
Practice Address - Street 1:1721 SIBLEY BLVD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-2240
Practice Address - Country:US
Practice Address - Phone:708-868-1770
Practice Address - Fax:708-868-3773
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190253601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice