MEDICARE: DR. NAYONGE SOH 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	1223P0221X	Pediatric Dentistry	019024889	IL

General Provider Information

NPI Number	:	1861140105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAYONGE SOH DDS

Provider Business Mailing Address
First Line	:	2329 IROQUOIS DR
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1033
Country	:	US
Telephone Number	:	773-742-1410
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 N ARLINGTON HEIGHTS RD STE 150
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1768
Country	:	US
Telephone Number	:	847-537-7695
Fax Number	:

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

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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