Healthcare Provider Details

I. General information

NPI: 1992616163
Provider Name (Legal Business Name): ELMIRA AZAR HEZARKHANI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N LARRABEE ST APT 905
CHICAGO IL
60654-7016
US

IV. Provider business mailing address

700 N LARRABEE ST APT 905
CHICAGO IL
60654-7016
US

V. Phone/Fax

Practice location:
  • Phone: 847-275-9227
  • Fax:
Mailing address:
  • Phone: 847-275-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: