Provider Demographics
NPI:1528334232
Name:CHU, NGOC QUANG
Entity type:Individual
Prefix:DR
First Name:NGOC
Middle Name:QUANG
Last Name:CHU
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 1:6306 DEMOCRACY BLVD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1664
Mailing Address - Country:US
Mailing Address - Phone:301-530-2622
Mailing Address - Fax:240-330-4188
Practice Address - Street 1:6306 DEMOCRACY BLVD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1664
Practice Address - Country:US
Practice Address - Phone:301-530-2622
Practice Address - Fax:240-330-4188
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102161223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1184898785OtherORGANIZATION