Provider Demographics
NPI:1114471596
Name:LAOHAVIRAPHAB, VALINTHORN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VALINTHORN
Middle Name:
Last Name:LAOHAVIRAPHAB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W ILLINOIS ST APT 2403
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7836
Mailing Address - Country:US
Mailing Address - Phone:347-556-6018
Mailing Address - Fax:
Practice Address - Street 1:4310 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4009
Practice Address - Country:US
Practice Address - Phone:773-254-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist