Healthcare Provider Details

I. General information

NPI: 1417601477
Provider Name (Legal Business Name): QUYNH THU NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W DEVON AVE
CHICAGO IL
60660-1302
US

IV. Provider business mailing address

1301 W DEVON AVE
CHICAGO IL
60660-1329
US

V. Phone/Fax

Practice location:
  • Phone: 773-751-7800
  • Fax:
Mailing address:
  • Phone: 773-296-7589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036181570
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: