Individual
SARA REBECA KANG SAMAYOA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
(773) 975-1600
Mailing address
811 W WELLINGTON AVE, CHICAGO, IL 60657-5123
(773) 871-2188
(773) 871-6353
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019.034051
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/07/2015
Last updated
06/18/2024
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