Individual
KESIA KEIKO ASAMI DE SOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2340 N CALIFORNIA AVE STE A, CHICAGO, IL 60647-6622
(773) 687-8377
Mailing address
436 E NORTH WATER ST UNIT D, CHICAGO, IL 60611-5559
(312) 881-9199
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.033113
IL
Other
Enumeration date
06/07/2021
Last updated
07/12/2021
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