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4801 W. Peterson Ave Ste #404 Chicago IL 60646 | |
| (773) 794-1299 | |
| (773) 794-1629 |
| Full Name | |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 4801 W. Peterson Ave, Chicago, Illinois |
| Authorized Official Name and Position | Jun Sup Lim (PRESIDENT) |
| Authorized Official Contact | 7737941299 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4801 W. Peterson Ave Ste #404 Chicago IL 60646 Ph: (773) 794-1299 | 4801 W. Peterson Ave Ste #404 Chicago IL 60646 Ph: (773) 794-1299 |
| NPI Number | 1174633275 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174633275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (Illinois) | Primary |
| 1223P0300X | Dentist - Periodontics | (Illinois) | Secondary |
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