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General NPI Number Information
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NPI Number | 1700220043
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Entity Type | Individual
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Provider Name | DR. PHIMON ATSAWASUWAN
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Gender | Male
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 1283 W. WESTGATE TERRACE
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City | CHICAGO
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State | IL
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Zip | 60607
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Country | US
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Telephone | 312-928-9728
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Fax | 815-293-2159
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Provider Business Mailing Address
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Address Line | 1283 W. WESTGATE TERRACE
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City | CHICAGO
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State | IL
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Zip | 60607
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Country | US
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Telephone | 312-928-9728
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Fax | 815-293-2159
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019028877
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License Number State | IL
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