1134270234 NPI number — DR. DONG HOON CHAE DDS

Table of content: DR. DONG HOON CHAE DDS (NPI 1134270234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134270234 NPI number — DR. DONG HOON CHAE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAE
Provider First Name:
DONG
Provider Middle Name:
HOON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAE
Provider Other First Name:
KENNETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134270234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 S PRAIRIE AVE
Provider Second Line Business Mailing Address:
#1004
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60605-3043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-291-0309
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 N NEW ENGLAND AVE
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60707-4432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-237-1608
Provider Business Practice Location Address Fax Number:
773-237-1609
Provider Enumeration Date:
01/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)