1801975131 NPI number — BENYA YOUNG DDS

Table of content: BENYA YOUNG DDS (NPI 1801975131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801975131 NPI number — BENYA YOUNG DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
BENYA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801975131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 N CHILDRENS PLZ
Provider Second Line Business Mailing Address:
#64
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60614-3363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-573-4515
Provider Business Mailing Address Fax Number:
312-573-8405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
467 W DEMING PL
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60614-1881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-327-2950
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  019025443 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 019025443 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com