Provider Demographics
NPI:1710056809
Name:MOY, CHI K (D D S)
Entity Type:Individual
Prefix:DR
First Name:CHI
Middle Name:K
Last Name:MOY
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:CHI
Other - Middle Name:KEUNG
Other - Last Name:MOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 W PHILLIP RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1799
Mailing Address - Country:US
Mailing Address - Phone:847-367-0556
Mailing Address - Fax:847-367-0576
Practice Address - Street 1:10 W PHILLIP RD
Practice Address - Street 2:SUITE 115
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1799
Practice Address - Country:US
Practice Address - Phone:847-367-0556
Practice Address - Fax:847-367-0576
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice