Individual provider Active NPI

Cassiopeia Suzuki-Ward, DDS

  • Dentist
  • Chicago, IL
National Provider Identifier
1205636214
Registry record updated Aug 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019037053 Issued in IL
Practice address
13247 S Baltimore Ave
Chicago, IL 60633-1431
Phone
(773) 309-4652
NPI assigned
Mar 18, 2025
Sex
Unspecified or another gender identity
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019037053 IL Primary

Addresses

Primary practice location

13247 S Baltimore Ave
Chicago, IL 60633-1431

Mailing address

13247 S Baltimore Ave
Chicago, IL 60633-1431
Phone (303) 436-6000

Other practice location 1

12059 Western Ave
Blue Island, IL 60406-1162
Phone (708) 371-3844

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1742256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1205636214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13247 S BALTIMORE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606331431",
            "telephone_number": "303-436-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13247 S BALTIMORE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606331431",
            "telephone_number": "773-309-4652"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12059 Western Ave",
            "address_purpose": "LOCATION",
            "city": "Blue Island",
            "state": "IL",
            "postal_code": "604061162",
            "country_code": "US",
            "telephone_number": "708-371-3844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUZUKI-WARD",
        "first_name": "CASSIOPEIA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2025-03-18",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019037053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; 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.