Healthcare Provider Details

I. General information

NPI: 1861655524
Provider Name (Legal Business Name): GEORGE LINH NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 S. MARYLAND AVE MC 4000
CHICAGO IL
60637
US

IV. Provider business mailing address

841 S. MARYLAND AVE MC 4000
CHICAGO IL
60637
US

V. Phone/Fax

Practice location:
  • Phone: 714-312-8707
  • Fax: 714-386-5308
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMT193699
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMT193699
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036137309
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT193699
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: