Basic Information
| Provider Information | |||||||||
| NPI: | 1649684796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUZHIN | ||||||||
| FirstName: | YELENA | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 N QUINCY ST | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222031907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032761010 | ||||||||
| FaxNumber: | 7035661300 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 GLENWOOD AVE SE STE 210 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303162024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042604767 | ||||||||
| FaxNumber: | 4046092508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2014 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DN015187 | GA | Y | Dental Providers | Dentist |
No ID Information.