| NPI | 1649387424 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHAM VAY UNG President/Owner 712-255-0502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA 00505) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2015-01-29 |