Provider Demographics
NPI:1700062700
Name:ASIAN VILLAGE DENTAL CLINIC
Entity Type:Organization
Organization Name:ASIAN VILLAGE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-275-8083
Mailing Address - Street 1:5129 N BROADWAY ST
Mailing Address - Street 2:E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3018
Mailing Address - Country:US
Mailing Address - Phone:773-275-8083
Mailing Address - Fax:773-275-9224
Practice Address - Street 1:5129 N BROADWAY ST
Practice Address - Street 2:E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3018
Practice Address - Country:US
Practice Address - Phone:773-275-8083
Practice Address - Fax:773-275-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190201651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty