Provider Demographics
NPI:1275243149
Name:CHWA, EVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:CHWA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MEADOW RD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3670
Mailing Address - Country:US
Mailing Address - Phone:847-272-0600
Mailing Address - Fax:
Practice Address - Street 1:1220 MEADOW RD STE 300
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-3670
Practice Address - Country:US
Practice Address - Phone:847-272-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0338421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics