Provider Demographics
NPI:1174187355
Name:NGUYEN, PHUONGHONG THI
Entity Type:Individual
Prefix:
First Name:PHUONGHONG
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2338
Mailing Address - Country:US
Mailing Address - Phone:562-430-2026
Mailing Address - Fax:562-594-0742
Practice Address - Street 1:3401 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2338
Practice Address - Country:US
Practice Address - Phone:562-430-2026
Practice Address - Fax:562-594-0742
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH50090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist