Provider Demographics
NPI:1679513642
Name:DINH, DZUNG HONG (MD)
Entity type:Individual
Prefix:
First Name:DZUNG
Middle Name:HONG
Last Name:DINH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 N WILLIAM KUMPF BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605
Mailing Address - Country:US
Mailing Address - Phone:309-676-0766
Mailing Address - Fax:309-676-5920
Practice Address - Street 1:719 N WILLIAM KUMPF BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605
Practice Address - Country:US
Practice Address - Phone:309-676-0766
Practice Address - Fax:309-676-5920
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076166207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061630Medicaid
IL036061630Medicaid
56220Medicare ID - Type Unspecified