Provider Demographics
NPI:1417357930
Name:NGUYEN, MAICHI SR
Entity Type:Individual
Prefix:
First Name:MAICHI
Middle Name:
Last Name:NGUYEN
Suffix:SR
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 1:1205 AUTUMNSONG WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131
Mailing Address - Country:US
Mailing Address - Phone:408-934-0204
Mailing Address - Fax:408-934-0301
Practice Address - Street 1:301 RANCH DR.
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035
Practice Address - Country:US
Practice Address - Phone:408-934-0204
Practice Address - Fax:408-934-0301
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist