Provider Demographics
NPI:1871602508
Name:CHAU, HIEP NGOC (MD)
Entity type:Individual
Prefix:MR
First Name:HIEP
Middle Name:NGOC
Last Name:CHAU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7487 SOUTH STATE ROAD 121
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063
Mailing Address - Country:US
Mailing Address - Phone:904-259-6211
Mailing Address - Fax:904-259-7104
Practice Address - Street 1:7487 S STATE ROAD 121
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-5451
Practice Address - Country:US
Practice Address - Phone:904-259-6211
Practice Address - Fax:904-259-7104
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 45192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD64914Medicare UPIN