Individual
KENNETH CHUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2446 WASHINGTON AVE, OCEANSIDE, NY 11572
(516) 536-0946
(516) 536-4495
Mailing address
3998 FAIR RIDGE DR, STE 300, FAIRFAX, VA 22033-2921
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
234375
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02711939
—
NY
Enumeration date
04/07/2006
Last updated
03/23/2015
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