Provider Demographics
NPI:1205937554
Name:UNG, KHAM V (DPM)
Entity type:Individual
Prefix:DR
First Name:KHAM
Middle Name:V
Last Name:UNG
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 1:1502 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1246
Mailing Address - Country:US
Mailing Address - Phone:712-255-0502
Mailing Address - Fax:712-258-9977
Practice Address - Street 1:1502 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1246
Practice Address - Country:US
Practice Address - Phone:712-255-0502
Practice Address - Fax:712-258-9977
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00505213ES0103X
SD123213ES0103X
NE224213ES0103X
MN675213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2991539Medicaid
SD6800454Medicaid
IAU52054Medicare UPIN
IA2991539Medicaid
IA1509Medicare PIN
NE270194Medicare PIN