Healthcare Provider Details

I. General information

NPI: 1124939939
Provider Name (Legal Business Name): CHAOPING LAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S WENTWORTH AVE
CHICAGO IL
60616-2012
US

IV. Provider business mailing address

3332 S NORMAL AVE
CHICAGO IL
60616-3513
US

V. Phone/Fax

Practice location:
  • Phone: 312-998-2899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: