Provider Demographics
NPI:1285794933
Name:HSU, CHAO-CHUNG (DMD)
Entity type:Individual
Prefix:DR
First Name:CHAO-CHUNG
Middle Name:
Last Name:HSU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 GOLDEN POND LN
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8083
Mailing Address - Country:US
Mailing Address - Phone:847-577-0455
Mailing Address - Fax:847-577-0455
Practice Address - Street 1:208 N DUNTON AVE STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5958
Practice Address - Country:US
Practice Address - Phone:847-577-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice