Provider Demographics
NPI:1730647744
Name:MOLAR CITY, P.C.
Entity Type:Organization
Organization Name:MOLAR CITY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GARSON
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-387-8715
Mailing Address - Street 1:2330 W SAINT PAUL AVE APT 602
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5617
Mailing Address - Country:US
Mailing Address - Phone:646-387-8715
Mailing Address - Fax:
Practice Address - Street 1:4620 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:708-552-0275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental