MEDICARE: CHINATOWN FAMILY DENTAL, LLC

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	261QD0000X	Dental Clinic/Center	19023705	IL

General Provider Information

NPI Number	:	1497147151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHINATOWN FAMILY DENTAL, LLC

Provider Business Mailing Address
First Line	:	238 WEST CERMAK ROAD
Second Line	:	2A
City	:	CHICAGO
State	:	IL
Zip	:	60616-2972
Country	:	US
Telephone Number	:	312-842-0888
Fax Number	:	312-842-7887

Provider Business Practice Location Address
First Line	:	238 W CERMAK RD
Second Line	:	2A
City	:	CHICAGO
State	:	IL
Zip	:	60616-2972
Country	:	US
Telephone Number	:	312-842-0888
Fax Number	:	312-842-7887

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SEVILA YEE-SCHIML
Credential	:
Telephone Number	:	312-842-0888

Provider Enumeration Date	:	03/04/2015
Last Update Date	:	03/04/2015

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