Healthcare Provider Details

I. General information

NPI: 1750272092
Provider Name (Legal Business Name): WANRONG RUAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W ARMITAGE AVE
CHICAGO IL
60647-3718
US

IV. Provider business mailing address

3223 S PARNELL AVE FL 2
CHICAGO IL
60616-3515
US

V. Phone/Fax

Practice location:
  • Phone: 773-276-9280
  • Fax:
Mailing address:
  • Phone: 312-714-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.036254
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: