# ASIAN VILLAGE MEDICAL CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548436892
- **Authorized official:** PHUONG TRAN MD (PRESIDENT)
- **Authorized official phone:** (773) 275-4250

## Contact information

- **Practice address:** 5129 N BROADWAY ST, SUITE E, CHICAGO, IL 60640-3018
- **Practice address phone:** (774) 275-4250
- **Practice address fax:** (773) 275-4263
- **Mailing address:** 5129 N BROADWAY ST, SUITE E, CHICAGO, IL 60640-3018
- **Mailing address phone:** (774) 275-4250
- **Mailing address fax:** (773) 275-4263

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 036089675 | IL | Yes |

## Other

- **Enumeration date:** 05/07/2008
- **Last updated:** 09/30/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 20000433 | — | IL |