Healthcare Provider Details

I. General information

NPI: 1295766145
Provider Name (Legal Business Name): CHAU MING NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E MAIN ST STE 2-7
HUNTINGTON NY
11743-2923
US

IV. Provider business mailing address

PO BOX 1064
EAST NORTHPORT NY
11731
US

V. Phone/Fax

Practice location:
  • Phone: 631-403-2375
  • Fax: 631-403-1182
Mailing address:
  • Phone: 631-403-2375
  • Fax: 206-339-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA73209
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number247136
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: