Chandara Im, DDS
Individual provider Active NPI Dentist · Ganado, AZ
NPI 1902184757 · NPPES record last updated Jul 28, 2011
Key facts
- NPI
- 1902184757
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 8233 (AZ)
- Practice address
- Arizona 264
Sage Memorial Hospital
Ganado, AZ 86505 - Phone
- (928) 755-4500
- NPI assigned
- Jul 28, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8233 | AZ | Yes |
Addresses
Primary practice location
Arizona 264
Sage Memorial Hospital
Ganado, AZ 86505
Mailing address
16421 N 150TH Dr
Surprise, AZ 85374-1473
Phone (480) 560-7603
Other providers in Ganado, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.