Provider Demographics
NPI:1598033623
Name:NGUYEN, CHINH
Entity Type:Individual
Prefix:
First Name:CHINH
Middle Name:
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 1:331 N SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4444
Mailing Address - Country:US
Mailing Address - Phone:310-640-9651
Mailing Address - Fax:310-414-9942
Practice Address - Street 1:331 N SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4444
Practice Address - Country:US
Practice Address - Phone:310-640-9651
Practice Address - Fax:310-414-9942
Is Sole Proprietor?:No
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH66256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist