Provider Demographics
NPI:1588630719
Name:DANG-DUC, VUONG ANH (MD)
Entity Type:Individual
Prefix:MR
First Name:VUONG
Middle Name:ANH
Last Name:DANG-DUC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:VERN
Other - Middle Name:
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1954 1ST ST STE 335
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3104
Mailing Address - Country:US
Mailing Address - Phone:847-433-5864
Mailing Address - Fax:847-433-5851
Practice Address - Street 1:1780 GREEN BAY RD STE 202
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3276
Practice Address - Country:US
Practice Address - Phone:847-433-5864
Practice Address - Fax:847-433-5851
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH77170Medicare UPIN