Provider Demographics
NPI:1558058347
Name:YU, RACHEAL (DMD)
Entity type:Individual
Prefix:
First Name:RACHEAL
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3478 N BROADWAY ST APT 234
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6968
Mailing Address - Country:US
Mailing Address - Phone:615-714-9057
Mailing Address - Fax:
Practice Address - Street 1:1202 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1908
Practice Address - Country:US
Practice Address - Phone:312-724-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.035126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist