Provider Demographics
NPI:1932516770
Name:CHANDI, KIRANJOT KAUR
Entity Type:Individual
Prefix:
First Name:KIRANJOT
Middle Name:KAUR
Last Name:CHANDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIRANJOT
Other - Middle Name:KAUR
Other - Last Name:CHANDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:350 N CLARK ST,
Mailing Address - Street 2:ST 600 C/O KOS SERVICES ,
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 N CLARK ST,
Practice Address - Street 2:ST 600 C/O KOS SERVICES ,
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654
Practice Address - Country:US
Practice Address - Phone:312-274-4524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190299351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice