Provider Demographics
NPI:1245709633
Name:NGHIEM, HUNG (PHARM D)
Entity type:Individual
Prefix:
First Name:HUNG
Middle Name:
Last Name:NGHIEM
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 1:17038 INDEPENDENCE WAY
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2123
Mailing Address - Country:US
Mailing Address - Phone:714-417-7945
Mailing Address - Fax:
Practice Address - Street 1:13052 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3535
Practice Address - Country:US
Practice Address - Phone:714-505-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist