Healthcare Provider Details

I. General information

NPI: 1790913895
Provider Name (Legal Business Name): PRAJWAL DHUNGEL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S CALIFORNIA AVE
CHICAGO IL
60608-1729
US

IV. Provider business mailing address

1500 S CALIFORNIA AVE
CHICAGO IL
60608-1729
US

V. Phone/Fax

Practice location:
  • Phone: 773-870-6010
  • Fax:
Mailing address:
  • Phone: 773-870-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125055333
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: