Provider Demographics
NPI:1295766145
Name:NGUYEN, CHAU MING (MD)
Entity type:Individual
Prefix:
First Name:CHAU
Middle Name:MING
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
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 1064
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-403-2375
Mailing Address - Fax:206-339-7108
Practice Address - Street 1:205 E MAIN ST STE 2-7
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2923
Practice Address - Country:US
Practice Address - Phone:631-403-2375
Practice Address - Fax:631-403-1182
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73209207N00000X
NY247136207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A732090Medicaid
CAH42882Medicare UPIN
NY56578EL261Medicare PIN
CAW15771Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAWA73209BMedicare ID - Type UnspecifiedMEDICARE NUMBER