Asian Village Medical Clinic PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

036089675 Issued in IL

Legal business name

ASIAN VILLAGE MEDICAL CLINIC PC

Practice address

5129 N Broadway St
Suite E
Chicago, IL 60640-3018

Phone

(774) 275-4250

Fax

(773) 275-4263

NPI assigned

May 7, 2008

Last updated

Sep 30, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Phuong Tran, MDNPI 1821137142

Title

President

Phone

(773) 275-4250

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Phuong Lien Tran, M.D.

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1821137142
  Medicare reassignment NPD Authorized official
• Linh Nguyen, DDS

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1033109996
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285804800000",
    "number": "1548436892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5129 N BROADWAY ST",
            "address_2": "SUITE E",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606403018",
            "telephone_number": "774-275-4250",
            "fax_number": "773-275-4263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5129 N BROADWAY ST",
            "address_2": "SUITE E",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606403018",
            "telephone_number": "774-275-4250",
            "fax_number": "773-275-4263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASIAN VILLAGE MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-07",
        "last_updated": "2010-09-30",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "PHUONG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-275-4250",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "036089675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20000433",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Asian Human Services, Inc.
• Asian Human Services, Inc.
• Asian Human Services, Inc. (Asian Human Services of Chicago, Inc)
• Asian Human Services, Inc. (Trellus)
• Asian Village Dental Clinic
• Mehar Gani Asim, O.D.
• Mohammed Adil Asim, DDS
• Angela Asimakopoulos, DNP
• Fotios Asimakopoulos, MD
• Georgios Nikolaos Asimis, MD

• Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.