NATHAN BOUNYONG DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125074180

License Status

CANCELLED

Business

Title

First Name

NATHAN

Last Name

BOUNYONG

Business Name

NATHAN BOUNYONG DO

Original Issue Date

07/01/2019

Effective Date

07/01/2019

Expiration Date

06/30/2022

City

CHICAGO

State

Zip

60625

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/15/2019