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Individual

KHAI VAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
16205 HARLEM AVE STE B, TINLEY PARK, IL 60477-1682
(708) 614-9301
Mailing address
8535 MENARD AVE, BURBANK, IL 60459-2660
(773) 627-0223

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.011264
IL

Other

Enumeration date
02/11/2019
Last updated
02/11/2019
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