MEDICARE: DR. DONG HOON CHAE 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	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1134270234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONG HOON CHAE DDS

Provider Business Mailing Address
First Line	:	1515 S PRAIRIE AVE
Second Line	:	#1004
City	:	CHICAGO
State	:	IL
Zip	:	60605-3043
Country	:	US
Telephone Number	:	312-291-0309
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N NEW ENGLAND AVE
Second Line	:	#1
City	:	CHICAGO
State	:	IL
Zip	:	60707-4432
Country	:	US
Telephone Number	:	773-237-1608
Fax Number	:	773-237-1609

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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