Healthcare Provider Details

I. General information

NPI: 1902423130
Provider Name (Legal Business Name): COZY RUAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 HANBURY RD E STE 110
CHESAPEAKE VA
23322-6623
US

IV. Provider business mailing address

270 W YORK ST UNIT 3606
NORFOLK VA
23510-1567
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-5948
  • Fax:
Mailing address:
  • Phone: 904-562-8894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401416973
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: