Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
KEVIN KHAMVONGSA
Active Sole ProprietorKEVIN KHAMVONGSA is a Community/Behavioral Health healthcare provider located in CRYSTAL LAKE, Illinois. NPI 1467907170 is currently active in the NPPES registry. Verify at CMS.
Community/Behavioral Health · CRYSTAL LAKE, IL
Registration Details
- NPI Number
- 1467907170
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Aug 23, 2016 (10.001932453777 yrs)
- Last Updated
- Aug 23, 2016
- License
-
S4S8C5H5 (IL)
- Sole Proprietor
- Yes
Practice Information
- Address
-
145 S VIRGINIA STCRYSTAL LAKE, IL, 600147226Browse IL providers · Browse ZIP 60014
- Phone
- 8154449999
- Primary Specialty
-
Community/Behavioral Health
251S00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.