# FOOT AND ANKLE CLINIC, PC

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

## Provider details

- **NPI number:** 1922304682
- **Authorized official:** DR. KHAM VAY UNG DPM (PRESIDENT/OWNER)
- **Authorized official phone:** (712) 255-0502

## Contact information

- **Practice address:** 810 N 22ND ST, BLAIR, NE 68008-1128
- **Practice address phone:** (402) 426-1239
- **Practice address fax:** (402) 426-1191
- **Mailing address:** 1502 PIERCE ST, SIOUX CITY, IA 51105-1246
- **Mailing address phone:** (712) 255-0502
- **Mailing address fax:** (712) 258-9977

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 00505 | IA | Yes |

## Other

- **Enumeration date:** 01/28/2011
- **Last updated:** 06/14/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0476317 | — | IA |
| 05 | — | 6800454 | — | SD |
| 05 | — | 6800690 | — | SD |
| 05 | — | 6800700 | — | SD |