Provider Demographics
NPI:1639539752
Name:DANG, QUOC TOMMY (DO)
Entity Type:Individual
Prefix:DR
First Name:QUOC
Middle Name:TOMMY
Last Name:DANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:TOMMY
Other - Middle Name:QUOC
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:5060 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3007
Mailing Address - Country:US
Mailing Address - Phone:773-293-8890
Mailing Address - Fax:
Practice Address - Street 1:4753 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4490
Practice Address - Country:US
Practice Address - Phone:773-205-7200
Practice Address - Fax:773-481-7577
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.147714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine