Provider Demographics
NPI:1578362760
Name:VANG, SAIKHAM
Entity type:Individual
Prefix:
First Name:SAIKHAM
Middle Name:
Last Name:VANG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W9583 CASCADE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-9669
Mailing Address - Country:US
Mailing Address - Phone:417-849-6823
Mailing Address - Fax:
Practice Address - Street 1:W9583 CASCADE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-9669
Practice Address - Country:US
Practice Address - Phone:417-849-6823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)