NPI | 1639188295 |
---|---|
Entity Type | Organization |
Authorized Contact | PETER SUNG JONG CHANG Co Owner 847-998-9660 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019024231) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019022395) |
Enumeration Date | 2006-08-05 |
Last Update Date | 2020-08-22 |