Active NPI
Stephanie A Nguyen, D.M.D.
- Dentist
- Evanston, IL
National Provider Identifier
1023468352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 018001996
- Practice address
- 2650 Ridge Ave
Suite 1304
Evanston, IL 60201-1718 - Phone
- (847) 570-2369
- NPI assigned
- Jun 17, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 018001996 | IL | Primary |
Addresses
Primary practice location
2650 Ridge Ave
Suite 1304
Evanston, IL 60201-1718
Mailing address
180 Harvester Dr
Suite 110
Burr Ridge, IL 60527-7594
Phone (773) 702-1150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160627000502 | IL | Order and Referring Only - Dentist | 6406147297 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018001996 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466121600000",
"number": "1023468352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 HARVESTER DR",
"address_2": "SUITE 110",
"city": "BURR RIDGE",
"state": "IL",
"postal_code": "605277594",
"telephone_number": "773-702-1150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 RIDGE AVE",
"address_2": "SUITE 1304",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602011718",
"telephone_number": "847-570-2369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "STEPHANIE",
"middle_name": "A",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-17",
"last_updated": "2016-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "018001996",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.