Healthcare Provider Details

I. General information

NPI: 1568305720
Provider Name (Legal Business Name): IMAN DAHABRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 NORTH AVE
OAK PARK IL
60302-1002
US

IV. Provider business mailing address

5279 W 89TH ST
OAK LAWN IL
60453-1321
US

V. Phone/Fax

Practice location:
  • Phone: 708-879-2112
  • Fax:
Mailing address:
  • Phone: 708-305-3739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: