Healthcare Provider Details

I. General information

NPI: 1710056809
Provider Name (Legal Business Name): CHI K MOY D. D. S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHI KEUNG MOY

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W PHILLIP RD SUITE 115
VERNON HILLS IL
60061-1799
US

IV. Provider business mailing address

10 W PHILLIP RD SUITE 115
VERNON HILLS IL
60061-1799
US

V. Phone/Fax

Practice location:
  • Phone: 847-367-0556
  • Fax: 847-367-0576
Mailing address:
  • Phone: 847-367-0556
  • Fax: 847-367-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: