Healthcare Provider Details

I. General information

NPI: 1356188569
Provider Name (Legal Business Name): LINH CHAU KHANH DANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E MADISON ST FL 3
SPRINGFIELD IL
62701-1035
US

IV. Provider business mailing address

PO BOX 19642
SPRINGFIELD IL
62794-9642
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax:
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125087883
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: