Provider Demographics
NPI:1164085742
Name:VANG, KABAO (MD)
Entity Type:Individual
Prefix:
First Name:KABAO
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KA BAO
Other - Middle Name:
Other - Last Name:VANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:2301 E 93RD ST STE 3610
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3913
Practice Address - Country:US
Practice Address - Phone:773-967-5932
Practice Address - Fax:773-967-5942
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390200000X
IL036.161524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program