Provider Demographics
NPI:1265091797
Name:NGUYEN, HOANG BA (PHARMD, MD, PHD)
Entity type:Individual
Prefix:DR
First Name:HOANG
Middle Name:BA
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD, MD, PHD
Other - Prefix:PROF
Other - First Name:HOANG
Other - Middle Name:BA
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, MD, PHD
Mailing Address - Street 1:3423 LINDY AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2201
Mailing Address - Country:US
Mailing Address - Phone:213-446-2519
Mailing Address - Fax:
Practice Address - Street 1:3423 LINDY AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2201
Practice Address - Country:US
Practice Address - Phone:213-446-2519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533541835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist