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General NPI Number Information
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NPI Number | 1649387424
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE CLINIC, PC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 1502 PIERCE ST
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City | SIOUX CITY
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State | IA
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Zip | 51105-1246
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Country | US
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Telephone | 712-255-0502
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Fax | 712-258-9977
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Provider Business Mailing Address
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Address Line | 1502 PIERCE ST
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City | SIOUX CITY
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State | IA
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Zip | 51105-1246
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Country | US
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Telephone | 712-255-0502
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Fax | 712-258-9977
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. KHAM VAY UNG
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Credential | DPM
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Telephone | 712-255-0502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 00505
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License Number State | IA
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