Provider Demographics
NPI:1649778267
Name:DUONG, KY HONG (MHP)
Entity Type:Individual
Prefix:
First Name:KY
Middle Name:HONG
Last Name:DUONG
Suffix:
Gender:M
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4753 N BROADWAY ST STE 700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4995
Mailing Address - Country:US
Mailing Address - Phone:773-293-8430
Mailing Address - Fax:773-728-4751
Practice Address - Street 1:4753 N BROADWAY ST STE 700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4995
Practice Address - Country:US
Practice Address - Phone:773-293-8430
Practice Address - Fax:773-728-4751
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)