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NPI Code Detail

MEDICARE: DR. CHRISTOPHER TSEUNMUN CHAN D.D.S.

MEDICARE: DR. CHRISTOPHER TSEUNMUN CHAN D.D.S.
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
11223G0001XGeneral Practice Dentistry019027611IL

General Provider Information

NPI Number : 1336308675
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOPHER TSEUNMUN CHAN D.D.S.
Provider Business Mailing Address
First Line : 430 W ERIE ST STE 200
Second Line :
City : CHICAGO
State : IL
Zip : 60610-6920
Country : US
Telephone Number : 920-838-1649
Fax Number :
Provider Business Practice Location Address
First Line : 4039 W NORTH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-5219
Country : US
Telephone Number : 773-782-4800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2008
Last Update Date : 06/02/2008

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