Provider Demographics
NPI:1598545394
Name:NGUYEN, TUNG KIEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:TUNG
Middle Name:KIEN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17142 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1717
Mailing Address - Country:US
Mailing Address - Phone:714-746-6863
Mailing Address - Fax:
Practice Address - Street 1:2353 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3027
Practice Address - Country:US
Practice Address - Phone:800-920-8879
Practice Address - Fax:909-599-7944
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist