# JENNY BARUCH DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659691467
- **Authorized official:** DR. JENNY KWON BARUCH DDS (DENTIST)
- **Authorized official phone:** (815) 477-2369

## Contact information

- **Practice address:** 805 S MCHENRY AVE, STE 1, CRYSTAL LAKE, IL 60014-7450
- **Practice address phone:** (815) 477-2369
- **Mailing address:** 805 S MCHENRY AVE, STE 1, CRYSTAL LAKE, IL 60014-7450
- **Mailing address phone:** (815) 477-2369

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 019028247 | IL | Yes |

## Other

- **Enumeration date:** 06/03/2010
- **Last updated:** 03/02/2012