1235472127 NPI number — DR. HARRIETT MAE HIDALGO CHAN D.C.

Table of content: DR. HARRIETT MAE HIDALGO CHAN D.C. (NPI 1235472127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235472127 NPI number — DR. HARRIETT MAE HIDALGO CHAN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAN
Provider First Name:
HARRIETT MAE
Provider Middle Name:
HIDALGO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUMANG
Provider Other First Name:
HARRIETT MAE
Provider Other Middle Name:
CHAN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235472127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7363 NORTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVER FOREST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60305-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-873-9841
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7363 NORTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVER FOREST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60305-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-209-1155
Provider Business Practice Location Address Fax Number:
708-209-1926
Provider Enumeration Date:
03/29/2013

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: 111N00000X , with the licence number:  038012377 , 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)





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