| 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 |