Organization
ASIAN VILLAGE MEDICAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHUONG TRAN MD (PRESIDENT)
(773) 275-4250
Entity
Organization
Contact information
Practice address
5129 N BROADWAY ST, SUITE E, CHICAGO, IL 60640-3018
(774) 275-4250
(773) 275-4263
Mailing address
5129 N BROADWAY ST, SUITE E, CHICAGO, IL 60640-3018
(774) 275-4250
(773) 275-4263
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
036089675
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20000433
—
IL
Enumeration date
05/07/2008
Last updated
09/30/2010
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