Healthcare Provider Details

I. General information

NPI: 1508971748
Provider Name (Legal Business Name): JESS BROWN VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

54 OAK CREEK COURT
BURR RIDGE IL
60527
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-6127
  • Fax: 312-569-6148
Mailing address:
  • Phone: 630-323-0357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. PENG LIANG HUANG
Title or Position: ATTENDING PHYSICIAN
Credential: M.D.
Phone: 312-569-6127