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General NPI Number Information
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NPI Number | 1124973631
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Entity Type | Organization
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Legal Business Name | JOSE VALLE DDS PC
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Dates
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Enumeration Date | 03/02/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 2021 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60647-7491
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Country | US
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Telephone | 708-714-7274
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Fax |
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Provider Business Mailing Address
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Address Line | 500 E 33RD ST
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City | CHICAGO
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State | IL
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Zip | 60616-4056
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. LEESI SATURDAY KOMI
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Credential | MD
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Telephone | 630-828-4141
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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 |
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License Number State |
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