Organization
FOOT AND ANKLE CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHAM VAY UNG DPM (PRESIDENT/OWNER)
(712) 255-0502
Entity
Organization
Contact information
Practice address
3405 6TH ST, BROOKINGS, SD 57006-4417
(605) 693-7246
(605) 693-7247
Mailing address
1502 PIERCE ST, SIOUX CITY, IA 51105-1246
(712) 255-0502
(712) 258-9977
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
00505
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0476317
—
IA
05
—
6800454
—
SD
05
—
6800690
—
SD
05
—
6800700
—
SD
Enumeration date
01/28/2011
Last updated
06/14/2016
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