Healthcare Provider Details

I. General information

NPI: 1811696172
Provider Name (Legal Business Name): KIM TAPIAWALA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 W NORTH AVE
CHICAGO IL
60647-5247
US

IV. Provider business mailing address

4437 RIPTIDE LN
PLANO TX
75024-7045
US

V. Phone/Fax

Practice location:
  • Phone: 312-666-3494
  • Fax:
Mailing address:
  • Phone: 469-243-7454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.036498
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number39696
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: