Provider Demographics
NPI:1376990853
Name:CENTER CITY ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:CENTER CITY ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAI-ZU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSED, MD
Authorized Official - Phone:215-290-9778
Mailing Address - Street 1:2422 NAUDAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1030
Mailing Address - Country:US
Mailing Address - Phone:215-290-9778
Mailing Address - Fax:
Practice Address - Street 1:1740 SOUTH ST STE 302
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1572
Practice Address - Country:US
Practice Address - Phone:267-437-7540
Practice Address - Fax:267-437-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0357841223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty