Healthcare Provider Details

I. General information

NPI: 1366377202
Provider Name (Legal Business Name): ERIC WING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 W FOSTER AVE
CHICAGO IL
60640-1479
US

IV. Provider business mailing address

318 W 24TH ST
CHICAGO IL
60616-2216
US

V. Phone/Fax

Practice location:
  • Phone: 872-888-9339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037162
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: