Provider Demographics
NPI:1881612414
Name:NGUYEN, CHAU NGOC (MD)
Entity type:Individual
Prefix:DR
First Name:CHAU
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 N RIVERSIDE RD STE G50
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2510
Mailing Address - Country:US
Mailing Address - Phone:816-671-4888
Mailing Address - Fax:816-671-4890
Practice Address - Street 1:802 N RIVERSIDE RD STE G50
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2510
Practice Address - Country:US
Practice Address - Phone:816-671-4888
Practice Address - Fax:816-671-4890
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004030207208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200387840AMedicaid
MOP00334976OtherRR MEDICARE
MO208332304Medicaid
MO159159Medicare UPIN
KS200387840AMedicaid