Provider Demographics
NPI:1548880289
Name:KANA YAJIMA DDS
Entity type:Organization
Organization Name:KANA YAJIMA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KANA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAJIMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-845-6071
Mailing Address - Street 1:200 W NORTHWEST HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3142
Mailing Address - Country:US
Mailing Address - Phone:847-255-5550
Mailing Address - Fax:847-259-3945
Practice Address - Street 1:200 W NORTHWEST HWY STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3142
Practice Address - Country:US
Practice Address - Phone:847-255-5500
Practice Address - Fax:847-259-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL172-012-6303OtherNPI