Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036.141192 | IL |
NPI | 1003201419 |
---|---|
Provider Name | Dr. Vehniah Kristin Tjong |
First Address | Chicago, IL 60611-2987 |
Second Address | Chicago, IL 60611-2987 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2015 |
Last Update Date | 09/08/2016 |