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General NPI Number Information
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NPI Number | 1205274602
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Entity Type | Organization
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Legal Business Name | NOAA
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Dates
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Enumeration Date | 06/06/2013
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Last Update Date | 06/06/2013
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Provider Practice Location Address
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Address Line | 1136 AMHERST CT
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City | LAKE ZURICH
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State | IL
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Zip | 60047-2776
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Country | US
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Telephone | 630-346-4996
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Fax |
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Provider Business Mailing Address
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Address Line | 1136 AMHERST CT
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City | LAKE ZURICH
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State | IL
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Zip | 60047-2776
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Country | US
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Telephone | 630-346-4996
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Fax |
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Authorized Official
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Title or Position | MEDICAL OFFICER
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Name | MR. HUNG TRAN
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Credential | PA-C
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Telephone | 630-346-4996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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