Organization
FOOT AND ANKLE CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHAM VAY UNG DPM (PRESIDENT/OWNER)
(712) 255-0502
Entity
Organization
Contact information
Practice address
315 N WASHINGTON ST, VIBORG, SD 57070-2002
(605) 326-5161
(605) 326-5734
Mailing address
1502 PIERCE ST, SIOUX CITY, IA 51105-1246
(712) 255-0502
(712) 258-9977
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
00505
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123
LICENSE NUMBER
SD
05
—
6800454
—
SD
Enumeration date
01/28/2011
Last updated
06/14/2016
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