Provider Demographics
NPI:1497147151
Name:CHINATOWN FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:CHINATOWN FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEVILA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEE-SCHIML
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-842-0888
Mailing Address - Street 1:238 WEST CERMAK ROAD
Mailing Address - Street 2:2A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2972
Mailing Address - Country:US
Mailing Address - Phone:312-842-0888
Mailing Address - Fax:312-842-7887
Practice Address - Street 1:238 W CERMAK RD
Practice Address - Street 2:2A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2972
Practice Address - Country:US
Practice Address - Phone:312-842-0888
Practice Address - Fax:312-842-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19023705261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental