| NPI | 1497027015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY CHANG Member 773-267-8600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019025589) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2014-10-01 |