MEDICARE: DR. ANHMINH TRANDAI DMD

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	:	1902897119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANHMINH TRANDAI DMD

Provider Business Mailing Address
First Line	:	8101 KILBOURN AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-3207
Country	:	US
Telephone Number	:	773-878-4800
Fax Number	:	773-878-8444

Provider Business Practice Location Address
First Line	:	5449 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1703
Country	:	US
Telephone Number	:	773-878-4800
Fax Number	:	773-878-8444

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	07/08/2007

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