Provider Demographics
NPI:1972125144
Name:NGUYEN, JASON DUY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DUY
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 1:13516 VINEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-9305
Mailing Address - Country:US
Mailing Address - Phone:714-269-4368
Mailing Address - Fax:
Practice Address - Street 1:14133 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-2205
Practice Address - Country:US
Practice Address - Phone:310-537-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist