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General NPI Number Information
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NPI Number | 1790689388
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Entity Type | Organization
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Legal Business Name | CENTER FOR VEIN RESTORATION OR LLC
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 1405 SE 164TH AVE STE 101
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City | VANCOUVER
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State | WA
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Zip | 98683-9644
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Country | US
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Telephone | 855-830-8346
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Fax | 240-473-4321
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Provider Business Mailing Address
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Address Line | 7474 GREENWAY CENTER DR STE 1000
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City | GREENBELT
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State | MD
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Zip | 20770-3500
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Country | US
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Telephone | 855-830-8346
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Fax | 240-473-4321
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Authorized Official
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Title or Position | CMO
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Name | KHANH QUOC NGUYEN
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Credential | DO
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Telephone | 301-498-6076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State | NULL
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