Individual provider Active NPI

Philip Nguyen

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1417747643
Registry record updated Jul 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019036230 Issued in IL
Practice address
712 E 87TH St
Chicago, IL 60619-6246
Phone
(773) 783-9000
NPI assigned
May 9, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019036230 IL Primary

Addresses

Primary practice location

712 E 87TH St
Chicago, IL 60619-6246

Mailing address

7039 Stone Run Dr
Brentwood, TN 37027-7898
Phone (615) 969-5984

Other practice location 1

17653 Torrence Ave
Lansing, IL 60438-4839
Phone (708) 418-8899

Other practice location 2

1 Chicago Ave
Oak Park, IL 60302-2432
Phone (708) 948-7744

Other practice location 3

2101 E 71st St
Chicago, IL 60649-2143
Phone (773) 241-7000

Other practice location 4

5622 W Touhy Ave
Niles, IL 60714-4001
Phone (847) 983-4202

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

LicenseStateTypeSpecialty
019036230ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Smiling Dental International P.C. CurrentSince May 11, 2025 Accepting new patients
Pro Dental Il - Chad Wise PC General Practice PastSince Sep 23, 2024 Accepting new patients
D2 Dental of Lansing, P.C. General Practice Past Accepting new patients

Locations

712 E 87th St
Chicago, IL 60619
Phone (773) 456-7071

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1746748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1417747643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7039 STONE RUN DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277898",
            "telephone_number": "615-969-5984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 E 87TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606196246",
            "telephone_number": "773-783-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17653 Torrence Ave",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "IL",
            "postal_code": "604384839",
            "country_code": "US",
            "telephone_number": "708-418-8899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Chicago Ave",
            "address_purpose": "LOCATION",
            "city": "Oak Park",
            "state": "IL",
            "postal_code": "603022432",
            "country_code": "US",
            "telephone_number": "708-948-7744",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2101 E 71st St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606492143",
            "country_code": "US",
            "telephone_number": "773-241-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5622 W Touhy Ave",
            "address_purpose": "LOCATION",
            "city": "Niles",
            "state": "IL",
            "postal_code": "607144001",
            "country_code": "US",
            "telephone_number": "847-983-4202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "PHILIP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-09",
        "last_updated": "2025-07-02",
        "certification_date": "2025-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019036230",
            "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 Jul 2, 2025; 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.