Healthcare Provider Details

I. General information

NPI: 1639710205
Provider Name (Legal Business Name): KENNY DUONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 SKOKIE BLVD
NORTHBROOK IL
60062-2805
US

IV. Provider business mailing address

1119 HAWTHORNE LN
ELK GROVE VILLAGE IL
60007-7239
US

V. Phone/Fax

Practice location:
  • Phone: 847-559-1214
  • Fax: 847-559-0052
Mailing address:
  • Phone: 714-495-8495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051302581
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051302581
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: