Healthcare Provider Details

I. General information

NPI: 1376878470
Provider Name (Legal Business Name): NIKOLAS V. CHUGAY SR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 ATLANTIC AVE
LONG BEACH CA
90807-2802
US

IV. Provider business mailing address

4210 ATLANTIC AVE
LONG BEACH CA
90807-2802
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-8507
  • Fax: 562-988-9220
Mailing address:
  • Phone: 562-595-8507
  • Fax: 562-988-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number20A3830
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number20A3830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: