Healthcare Provider Details

I. General information

NPI: 1265476840
Provider Name (Legal Business Name): JOANN KOCHIKARAN D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 N WOLF RD
MOUNT PROSPECT IL
60056-2735
US

IV. Provider business mailing address

4731 LINDEN AVE
GLENVIEW IL
60025-1424
US

V. Phone/Fax

Practice location:
  • Phone: 847-824-5151
  • Fax:
Mailing address:
  • Phone: 312-217-2486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019026731
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: