Provider Demographics
NPI:1346912441
Name:HOANG, PATRICK KIM NGUYEN
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:KIM NGUYEN
Last Name:HOANG
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 1:5886 MOWRY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5367
Mailing Address - Country:US
Mailing Address - Phone:510-573-0064
Mailing Address - Fax:510-573-0096
Practice Address - Street 1:5866 MOWRY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5367
Practice Address - Country:US
Practice Address - Phone:510-573-0064
Practice Address - Fax:510-573-0096
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist