Healthcare Provider Details

I. General information

NPI: 1376447953
Provider Name (Legal Business Name): CENTER FOR VEIN RESTORATION OR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 SE 91ST AVE STE 200
HAPPY VALLEY OR
97086-3756
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 1000
GREENBELT MD
20770-3500
US

V. Phone/Fax

Practice location:
  • Phone: 855-830-8346
  • Fax: 240-473-4321
Mailing address:
  • Phone: 855-860-8346
  • Fax: 240-473-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KHANH QUOC NGUYEN
Title or Position: CMO
Credential:
Phone: 301-498-6076