Individual
TUYET QUACH KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
211 E ONTARIO ST STE 200, CHICAGO, IL 60611-3284
(312) 694-7000
Mailing address
211 E ONTARIO ST STE 200, CHICAGO, IL 60611-3284
(312) 694-7000
(312) 926-6274
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004740
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
366426
STATE L&I
WA
Enumeration date
08/08/2013
Last updated
06/17/2020
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