Individual
KELLY VUONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
885 ROOSEVELT RD STE 201, GLEN ELLYN, IL 60137-6141
(630) 545-3760
(630) 545-3769
Mailing address
885 ROOSEVELT RD STE 201, GLEN ELLYN, IL 60137-6141
(630) 545-3760
(630) 545-3769
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036110420
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110420
—
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147101
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CA4748
RAILROAD MEDICARE PTAN (GROUP)
IL
01
—
P01053223
RAILROAD MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
07/12/2005
Last updated
10/07/2019
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