Provider Demographics
NPI:1760634687
Name:JOUNG EUN SONG, DDS, PC
Entity type:Organization
Organization Name:JOUNG EUN SONG, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOUNG
Authorized Official - Middle Name:EUN
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-724-0980
Mailing Address - Street 1:2640 PATRIOT BLVD
Mailing Address - Street 2:STE 230
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8075
Mailing Address - Country:US
Mailing Address - Phone:847-724-0980
Mailing Address - Fax:847-724-0981
Practice Address - Street 1:2640 PATRIOT BLVD
Practice Address - Street 2:STE 230
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8075
Practice Address - Country:US
Practice Address - Phone:847-724-0980
Practice Address - Fax:847-724-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190236781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty