Individual
KHANH P NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4614 S KEDZIE AVE, 2020 N. CALIFORNIA AVE UNIT 5, CHICAGO, IL 60632-2945
(773) 772-8001
Mailing address
212 E CULLERTON ST APT 712, CHICAGO, IL 60616-1293
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9179327
—
IL
Enumeration date
05/04/2007
Last updated
07/08/2007
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