Healthcare Provider Details

I. General information

NPI: 1669844619
Provider Name (Legal Business Name): LYUBOV KUCHINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYUBOV KUCHINA PTA

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8655W FOSTER AVE
CHICAGO IL
60656-1214
US

IV. Provider business mailing address

8655 W FOSTER AVE
CHICAGO IL
60656-3100
US

V. Phone/Fax

Practice location:
  • Phone: 773-653-8486
  • Fax:
Mailing address:
  • Phone: 773-653-8486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227014294
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: