Provider Demographics
NPI:1134270234
Name:CHAE, DONG HOON (DDS)
Entity type:Individual
Prefix:DR
First Name:DONG
Middle Name:HOON
Last Name:CHAE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:
Other - Last Name:CHAE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1515 S PRAIRIE AVE
Mailing Address - Street 2:#1004
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3043
Mailing Address - Country:US
Mailing Address - Phone:312-291-0309
Mailing Address - Fax:
Practice Address - Street 1:1600 N NEW ENGLAND AVE
Practice Address - Street 2:#1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-4432
Practice Address - Country:US
Practice Address - Phone:773-237-1608
Practice Address - Fax:773-237-1609
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice