MEDICARE: JOSE VALLE DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1124973631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE VALLE DDS PC

Provider Business Mailing Address
First Line	:	500 E 33RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-7491
Country	:	US
Telephone Number	:	708-714-7274
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. LEESI SATURDAY KOMI
Credential	:	MD
Telephone Number	:	630-828-4141

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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