Kevin Khamvongsa

NPI 1467907170 · on the registry since 2016 · sole proprietor

Practice

Address: 145 S Virginia St
Crystal Lake, IL 60014
Phone: (815) 444-9999
Organisation at this address: Mathers Clinic Llc
Mathers Clinic, Llc
Mathers Recovery Llc
Dr Raman Popli And Associates
Mathers Community Mental Health Center Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 26

Registry record

Primary taxonomy: 251S00000X
251S00000X
Licence states on file: IL
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2016-08-23

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois