MEDICARE: DR. KAPIL VIJ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019-025148	IL

General Provider Information

NPI Number	:	1104013762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAPIL VIJ DDS

Provider Business Mailing Address
First Line	:	259 E RAND RD
Second Line	:	#110
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2184
Country	:	US
Telephone Number	:	847-321-9445
Fax Number	:

Provider Business Practice Location Address
First Line	:	259 E RAND RD
Second Line	:	#110
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2184
Country	:	US
Telephone Number	:	847-321-9445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	08/06/2014

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