Glamour Dental South Chicago Heights LLC

Primary specialty

DentistTaxonomy code 122300000X

License

019025360 Issued in IL

Legal business name

GLAMOUR DENTAL SOUTH CHICAGO HEIGHTS LLC

Practice address

3330 Chicago Rd
South Chicago Heights, IL 60411-5423

Phone

(708) 248-5108

NPI assigned

Mar 26, 2014

Organization subpart

No

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

Authorized official

Name

Inchun Yang

Title

Owner

Phone

(224) 392-2403

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395792000000",
    "number": "1649697806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 MARKET ST",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 CHICAGO RD",
            "city": "SOUTH CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604115423",
            "telephone_number": "708-248-5108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLAMOUR DENTAL SOUTH CHICAGO HEIGHTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-26",
        "last_updated": "2014-03-26",
        "status": "A",
        "authorized_official_last_name": "YANG",
        "authorized_official_first_name": "INCHUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "224-392-2403"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019025360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in South Chicago Heights, IL
• Providers in South Chicago Heights, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; 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.