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General NPI Number Information
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NPI Number | 1447453410
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Entity Type | Individual
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Provider Name | RICHARD CHI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 3210 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60629-3325
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Country | US
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Telephone | 773-776-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 S PRAIRIE AVE UNIT 1708
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City | CHICAGO
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State | IL
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Zip | 60605-3141
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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 |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.027335
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License Number State | IL
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