Healthcare Provider Details

I. General information

NPI: 1356876635
Provider Name (Legal Business Name): LAUREN MING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 S STEWART AVE
CHICAGO IL
60621-3116
US

IV. Provider business mailing address

2550 W ADDISON ST
CHICAGO IL
60618-5952
US

V. Phone/Fax

Practice location:
  • Phone: 773-962-3976
  • Fax:
Mailing address:
  • Phone: 773-423-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019031245
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: