Healthcare Provider Details

I. General information

NPI: 1871974576
Provider Name (Legal Business Name): EDWARD NGUYEN M.D.,PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N KINGSBURY ST STE RW-6
CHICAGO IL
60610-7461
US

IV. Provider business mailing address

900 N KINGSBURY ST STE RW-6
CHICAGO IL
60610-7461
US

V. Phone/Fax

Practice location:
  • Phone: 405-816-2077
  • Fax:
Mailing address:
  • Phone: 312-222-8230
  • Fax: 312-467-0743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number036.170188
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number036.170188
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: