Provider Demographics
NPI:1114605896
Name:TRAN, CECILIA HUNG NGOC
Entity Type:Individual
Prefix:
First Name:CECILIA HUNG
Middle Name:NGOC
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 S HIGHLAND AVE APT 515
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5368
Mailing Address - Country:US
Mailing Address - Phone:408-768-4732
Mailing Address - Fax:
Practice Address - Street 1:2015 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3909
Practice Address - Country:US
Practice Address - Phone:773-904-7079
Practice Address - Fax:773-698-7832
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0344391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice