Provider Demographics
NPI:1457316978
Name:NGUYEN, CHRISTOPE LIEM
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPE
Middle Name:LIEM
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST FL 3
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-560-1900
Practice Address - Fax:864-560-1925
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21507208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH841603365OtherMEDICARE PIN
SCP00691777OtherRR MEDICARE
SCP01099013OtherRAILROAD MEDICARE
NC5903934Medicaid
SC215074Medicaid
SC215074Medicaid
SCH841607628Medicare PIN
SCH84160Medicare PIN
SCH841603365Medicare PIN