Individual
DAT LY NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2649 S 75 TH STREET, CHICAGO, IL 60649-3835
(773) 721-5845
(773) 721-5842
Mailing address
7855 SOUTH SHORE DR, 3E, CHICAGO, IL 60649-5497
(773) 721-5845
(773) 721-5842
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
056007022
IL
Other
Enumeration date
06/10/2010
Last updated
06/10/2010
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