MEDICARE: GUYEN GANBAGANGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	RBT24-358290	IL

General Provider Information

NPI Number	:	1396681433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUYEN GANBAGANGA

Provider Business Mailing Address
First Line	:	1721 MOON LAKE BLVD
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1069
Country	:	US
Telephone Number	:	708-378-3585
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 MOON LAKE BLVD
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1069
Country	:	US
Telephone Number	:	708-378-3585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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Directions to “ GUYEN GANBAGANGA ” Practice Location

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