Lidiane Fumiko Takeda, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.034563 Issued in IL

Practice address

567 W 14TH St
Chicago Heights, IL 60411-2386

Phone

(708) 283-9800

Fax

(708) 283-9801

NPI assigned

Jun 23, 2023

Last updated

Aug 3, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1013693183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15630 ARIS CT",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604627712",
            "telephone_number": "213-820-7456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "567 W 14TH ST",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604112386",
            "telephone_number": "708-283-9800",
            "fax_number": "708-283-9801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKEDA",
        "first_name": "LIDIANE",
        "middle_name": "FUMIKO",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-23",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.034563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Chicago Heights, IL
• Providers in Chicago Heights, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.