Healthcare Provider Details

I. General information

NPI: 1255593349
Provider Name (Legal Business Name): CHAU MINH DAO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 W MONTROSE AVE SUITE 101
CHICAGO IL
60613-5813
US

IV. Provider business mailing address

2516 W PETERSON AVE
CHICAGO IL
60659-4109
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-9160
  • Fax: 773-989-9165
Mailing address:
  • Phone: 773-743-4050
  • Fax: 773-743-3711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019025873
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: