Healthcare Provider Details

I. General information

NPI: 1215548375
Provider Name (Legal Business Name): CENTER FOR VEIN RESTORATION TN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 COWART ST STE 321
CHATTANOOGA TN
37408-1179
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 100
GREENBELT MD
20770-3567
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KHANH Q NGUYEN
Title or Position: PRESIDENT
Credential: DO
Phone: 855-830-8346