Provider Demographics
NPI:1215318027
Name:TIEN, CHIEH-LI (DDS)
Entity type:Individual
Prefix:
First Name:CHIEH-LI
Middle Name:
Last Name:TIEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2515
Mailing Address - Country:US
Mailing Address - Phone:646-416-0230
Mailing Address - Fax:
Practice Address - Street 1:575 W MADISON ST
Practice Address - Street 2:APT 1806
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2515
Practice Address - Country:US
Practice Address - Phone:646-416-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319020357019031017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist