MEDICARE: CHRISTOPHER K CHING 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	:	1871717983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER K CHING DDS

Provider Business Mailing Address
First Line	:	116 N LOCUST ST
Second Line	:	PO BOX 604
City	:	MOMENCE
State	:	IL
Zip	:	60954-1508
Country	:	US
Telephone Number	:	815-472-6403
Fax Number	:	815-472-2570

Provider Business Practice Location Address
First Line	:	116 N LOCUST ST
Second Line	:
City	:	MOMENCE
State	:	IL
Zip	:	60954-1508
Country	:	US
Telephone Number	:	815-472-6403
Fax Number	:	815-472-3807

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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