MEDICARE: DR. NGOC-TUYEN THI PHI 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	019022077	IL

General Provider Information

NPI Number	:	1376764431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGOC-TUYEN THI PHI DDS

Provider Business Mailing Address
First Line	:	4945 N BROADWAY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640
Country	:	US
Telephone Number	:	773-275-1280
Fax Number	:	773-275-1267

Provider Business Practice Location Address
First Line	:	2424 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4100
Country	:	US
Telephone Number	:	773-761-0300
Fax Number	:	773-761-0009

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	03/14/2023

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