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4759 N Ashland Ave Chicago IL 60640-3406 | |
| (773) 808-7744 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4759 N Ashland Ave, Chicago, Illinois |
| Authorized Official Name and Position | Jongnok Jennifer Lee (PRESIDENT) |
| Authorized Official Contact | 7738087744 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4759 N Ashland Ave Chicago IL 60640-3406 Ph: (773) 808-7744 | 4759 N Ashland Ave Chicago IL 60640-3406 Ph: (773) 808-7744 |
| NPI Number | 1801463187 |
|---|---|
| Provider Enumeration Date | 06/07/2021 |
| Last Update Date | 06/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801463187 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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