Provider Demographics
NPI:1639766496
Name:NGUYEN, NATHAN KHA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:KHA
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 1:140 WAYPOINT
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-3757
Mailing Address - Country:US
Mailing Address - Phone:949-813-8033
Mailing Address - Fax:
Practice Address - Street 1:1676 W KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-3015
Practice Address - Country:US
Practice Address - Phone:714-956-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist