Provider Demographics
NPI:1437713427
Name:NGUYEN, KEVIN NHAN
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:NHAN
Last Name:NGUYEN
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 1:1535 E KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5025
Mailing Address - Country:US
Mailing Address - Phone:714-639-6060
Mailing Address - Fax:
Practice Address - Street 1:1535 E KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5025
Practice Address - Country:US
Practice Address - Phone:714-639-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist