Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 20A3830 | CA |
Y | 208200000X | Surgeon | 20A3830 | CA |
Y | 208600000X | Surgeon | 20A3830 | CA |
NPI | 1376878470 |
---|---|
Provider Name | Dr. Nikolas V. Chugay SR. |
First Address | Long Beach, CA 90807-2802 |
Second Address | Long Beach, CA 90807-2802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2009 |
Last Update Date | 07/10/2009 |