Provider Demographics
NPI:1659027605
Name:NGUYEN, PHONG DONG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHONG
Middle Name:DONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 CALLE DEL HUMO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1212
Mailing Address - Country:US
Mailing Address - Phone:858-598-7001
Mailing Address - Fax:
Practice Address - Street 1:8210 CALLE DEL HUMO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-1212
Practice Address - Country:US
Practice Address - Phone:858-598-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty