Provider Demographics
NPI:1023892122
Name:MALHOTRA, AAKSHI
Entity type:Individual
Prefix:
First Name:AAKSHI
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N WELLS ST APT 1708
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1329
Mailing Address - Country:US
Mailing Address - Phone:310-893-9503
Mailing Address - Fax:
Practice Address - Street 1:3057 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3548
Practice Address - Country:US
Practice Address - Phone:773-257-0200
Practice Address - Fax:773-257-0227
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034622122300000X, 1223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program