Provider Demographics
NPI:1740241967
Name:VANG, CHAO (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHAO
Middle Name:
Last Name:VANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 VALLE VISTA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6239
Mailing Address - Country:US
Mailing Address - Phone:309-347-6121
Mailing Address - Fax:309-347-8010
Practice Address - Street 1:1503 VALLE VISTA BLVD STE C
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6239
Practice Address - Country:US
Practice Address - Phone:309-347-6121
Practice Address - Fax:309-347-8010
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004868213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL450540Medicare ID - Type Unspecified
U71068Medicare UPIN