Provider Demographics
NPI:1508063918
Name:NGUYEN, CHRISTINE VAN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VAN
Other - Middle Name:THANH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:844 N 29TH ST
Mailing Address - Street 2:UNIT 107
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1142
Mailing Address - Country:US
Mailing Address - Phone:619-278-9706
Mailing Address - Fax:
Practice Address - Street 1:1400 S 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-5919
Practice Address - Country:US
Practice Address - Phone:215-467-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431452208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics