Healthcare Provider Details

I. General information

NPI: 1457466732
Provider Name (Legal Business Name): HENRY NG CHUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 170TH ST STE 411
NORTH MIAMI BEACH FL
33169-5513
US

IV. Provider business mailing address

PO BOX 402514
MIAMI BEACH FL
33140-0514
US

V. Phone/Fax

Practice location:
  • Phone: 305-249-5666
  • Fax: 305-249-5669
Mailing address:
  • Phone: 305-249-5666
  • Fax: 305-249-5669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME39730
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME39730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: