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General NPI Number Information
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NPI Number | 1144376252
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Entity Type | Organization
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Legal Business Name | COLORADO DERMATOLOGY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14501 MAGNOLIA ST SUITE 103
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City | WESTMINSTER
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State | CA
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Zip | 92683-5542
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Country | US
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Telephone | 714-677-0877
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Fax | 714-677-0875
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Provider Business Mailing Address
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Address Line | 14501 MAGNOLIA ST SUITE 103
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City | WESTMINSTER
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State | CA
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Zip | 92683-5542
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Country | US
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Telephone | 714-677-0877
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Fax | 714-677-0875
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHAU MINH NGUYEN
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Credential | MD
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Telephone | 714-677-0877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A73209
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License Number State | CA
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