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General NPI Number Information
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NPI Number | 1114605896
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Entity Type | Individual
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Provider Name | CECILIA HUNG NGOC TRAN
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Gender | Female
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 2015 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60618-3909
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Country | US
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Telephone | 773-904-7079
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Fax | 773-698-7832
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Provider Business Mailing Address
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Address Line | 2720 S HIGHLAND AVE APT 515
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City | LOMBARD
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State | IL
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Zip | 60148-5368
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Country | US
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Telephone | 408-768-4732
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.034439
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License Number State | IL
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