Provider Demographics
NPI:1558484196
Name:CHHAY, VUTHIK T (PA-C)
Entity Type:Individual
Prefix:MR
First Name:VUTHIK
Middle Name:T
Last Name:CHHAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5316 N LEAVITT ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1113
Mailing Address - Country:US
Mailing Address - Phone:773-561-3727
Mailing Address - Fax:773-826-9601
Practice Address - Street 1:4800 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3223
Practice Address - Country:US
Practice Address - Phone:773-826-9600
Practice Address - Fax:773-826-9601
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant