Active NPI
Husam Hiwiadi, DMD
- General Practice Dentistry
- Waukegan, IL
National Provider Identifier
1689305765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.033617
- Practice address
- 3953 Fountain Square PL
Waukegan, IL 60085-6705 - Phone
- (817) 793-8559
- NPI assigned
- Jun 21, 2022
- Last updated
- Jun 29, 2022
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.033617 | IL | Primary |
Addresses
Primary practice location
3953 Fountain Square PL
Waukegan, IL 60085-6705
Mailing address
450 Warrenville Rd Apt 455
Lisle, IL 60532-1664
Phone (817) 793-8559
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 |
|---|---|---|---|
| 019.033617 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656460800000",
"number": "1689305765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 WARRENVILLE RD APT 455",
"city": "LISLE",
"state": "IL",
"postal_code": "605321664",
"telephone_number": "817-793-8559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3953 FOUNTAIN SQUARE PL",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600856705",
"telephone_number": "817-793-8559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HIWIADI",
"first_name": "HUSAM",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-21",
"last_updated": "2022-06-29",
"certification_date": "2022-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.033617",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.