Individual
KHAUNSAVAN VONGPHAKDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2650 RIDGE AVE, EVANSTON, IL 60201-1781
(847) 570-2000
Mailing address
2650 RIDGE AVE, EVANSTON, IL 60201-1781
(847) 570-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
085010441
IL
Other
Enumeration date
05/09/2024
Last updated
05/13/2024
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