Active NPI
Wayne NG, DDS
- Dentist
- Chicago, IL
National Provider Identifier
1215146774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 319010921
- Practice address
- 2054 W Devon Ave
Chicago, IL 60659-2128 - Phone
- (773) 465-8901
- Fax
- (847) 324-9476
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 319010921 | IL | Primary |
Addresses
Primary practice location
2054 W Devon Ave
Chicago, IL 60659-2128
Mailing address
2054 W Devon Ave
Chicago, IL 60659-2128
Phone (773) 465-8901
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 319010921 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730851200000",
"number": "1215146774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2054 W DEVON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606592128",
"telephone_number": "773-465-8901",
"fax_number": "847-324-9476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2054 W DEVON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606592128",
"telephone_number": "773-465-8901",
"fax_number": "847-324-9476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NG",
"first_name": "WAYNE",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2024-11-06",
"certification_date": "2024-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "319010921",
"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 Nov 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.