Revich, Yelena M
Revich, Yelena M is an sole proprietor health care provider with primary practice located at 3205 W Irving Park Rd , Chicago IL 60618-3301. She recently has only one registered license in Dental Providers / Dentist, which is considered as her primary health care specialty. Revich, Yelena M can be contacted via phone (332) 267-2671.Contact Information
Primary practice address
3205 W Irving Park Rd
Chicago IL 60618-3301
Phone: (332) 267-2671
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 019026450 | Illinois |
Profile Details
| NPI number | 1639169956 |
|---|---|
| LBN Legal business name | Revich, Yelena M |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 27th, 2005 |
| Last updated | Dec 12th, 2012 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639169956 | NPPES |
| Illinois | MEDICAID | 9177154 |
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