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NPI Code Detail

MEDICARE: DR. WENLI LOO

MEDICARE:  DR. WENLI  LOO
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 Dentistry019027056IL

General Provider Information

NPI Number : 1922130269
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WENLI LOO
Provider Business Mailing Address
First Line : 2310 W WABANSIA AVE
Second Line : #2W
City : CHICAGO
State : IL
Zip : 60647-5963
Country : US
Telephone Number : 917-923-5685
Fax Number :
Provider Business Practice Location Address
First Line : 4724 N KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-4421
Country : US
Telephone Number : 773-583-4455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 02/15/2008

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Directions to “ DR. WENLI LOO ” Practice Location

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