Provider Demographics
NPI:1811966203
Name:HAHN, CHIN-LO (DDS, MS, PHD)
Entity type:Individual
Prefix:
First Name:CHIN-LO
Middle Name:
Last Name:HAHN
Suffix:
Gender:F
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:748 LEXINGTON ST APT 38
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2050
Mailing Address - Country:US
Mailing Address - Phone:402-472-6280
Mailing Address - Fax:
Practice Address - Street 1:748 LEXINGTON ST APT 38
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2050
Practice Address - Country:US
Practice Address - Phone:402-610-0974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.10652.GD122300000X
SC106731223E0200X
IL019034987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics