Provider Demographics
NPI:1639569288
Name:NGUYEN, DIEM THI-MONG (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DIEM
Middle Name:THI-MONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:DIEM
Other - Middle Name:THI-MONG
Other - Last Name:VAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:15411 W 89TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1167
Mailing Address - Country:US
Mailing Address - Phone:913-438-7756
Mailing Address - Fax:
Practice Address - Street 1:15411 W 89TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1167
Practice Address - Country:US
Practice Address - Phone:913-438-7756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist