Provider Demographics
NPI:1851130785
Name:FARHAN, YASMINE (DMD)
Entity type:Individual
Prefix:DR
First Name:YASMINE
Middle Name:
Last Name:FARHAN
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 1:156 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6189
Mailing Address - Country:US
Mailing Address - Phone:708-790-7424
Mailing Address - Fax:
Practice Address - Street 1:5601 W MONEE MANHATTAN RD
Practice Address - Street 2:
Practice Address - City:MONEE
Practice Address - State:IL
Practice Address - Zip Code:60449-8862
Practice Address - Country:US
Practice Address - Phone:708-543-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.035070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist