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General NPI Number Information
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NPI Number | 1508971748
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Entity Type | Organization
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Legal Business Name | JESS BROWN VAMC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 820 S DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3728
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Country | US
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Telephone | 312-569-6127
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Fax | 312-569-6148
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Provider Business Mailing Address
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Address Line | 54 OAK CREEK COURT
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City | BURR RIDGE
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State | IL
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Zip | 60527
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Country | US
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Telephone | 630-323-0357
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Fax |
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Authorized Official
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Title or Position | ATTENDING PHYSICIAN
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Name | DR. PENG LIANG HUANG
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Credential | M.D.
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Telephone | 312-569-6127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2865M2000X
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Taxonomy Name | Military General Acute Care Hospital
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License Number |
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License Number State | IL
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