Provider Demographics
NPI:1396198297
Name:NGUYEN, KHANH (PHARMD)
Entity type:Individual
Prefix:
First Name:KHANH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 W 179TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4011
Mailing Address - Country:US
Mailing Address - Phone:310-619-9441
Mailing Address - Fax:
Practice Address - Street 1:8694 LAKE MURRAY BOULEVARD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CALIFORNIA
Practice Address - Zip Code:92119
Practice Address - Country:UM
Practice Address - Phone:619-460-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist