SAMANTHA CHAU PHUNG DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125072819

License Status

EXPIRED

Business

Title

First Name

SAMANTHA

Middle

CHAU

Last Name

PHUNG

Business Name

SAMANTHA CHAU PHUNG DO

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2023

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

03/06/2024