Provider Demographics
NPI:1376764431
Name:PHI, NGOC-TUYEN THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:NGOC-TUYEN
Middle Name:THI
Last Name:PHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:NGOC-TUYEN
Other - Last Name:PHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4945 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-275-1280
Mailing Address - Fax:773-275-1267
Practice Address - Street 1:2424 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4100
Practice Address - Country:US
Practice Address - Phone:773-761-0300
Practice Address - Fax:773-761-0009
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022077122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist