NPIMap

Organization Active NPI

Perla Dental 26TH Street LLC

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1639239478
Registry record updated Mar 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PERLA DENTAL 26TH STREET LLC
Practice address
3948 W 26TH St
Ste 101
Chicago, IL 60623-3738
Phone
(773) 521-1190
Fax
(773) 521-1147
NPI assigned
Dec 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2008

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

Authorized official

Name
Dr. Vicken Ichkhan, D.D.S.NPI 1013966266
Title
Dentist
Phone
(773) 521-1190

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X IL Primary

Addresses

Primary practice location

3948 W 26TH St
Ste 101
Chicago, IL 60623-3738

Mailing address

3948 W 26TH St
Ste 101
Chicago, IL 60623-3738
Phone (773) 521-1190

Other names 1

  • Perla Dental Former legal business name

National Provider Directory

National Provider Directory

Locations

3948 W 26th St
Ste 101
Chicago, IL 60623
Phone (773) 521-1190

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206662400000",
    "number": "1639239478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3948 W 26TH ST",
            "address_2": "STE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606233738",
            "telephone_number": "773-521-1190",
            "fax_number": "773-521-1147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3948 W 26TH ST",
            "address_2": "STE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606233738",
            "telephone_number": "773-521-1190",
            "fax_number": "773-521-1147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERLA DENTAL 26TH STREET LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2008-03-28",
        "status": "A",
        "authorized_official_last_name": "ICHKHAN",
        "authorized_official_first_name": "VICKEN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "773-521-1190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Perla Dental",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Mar 28, 2008; 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.