Provider Demographics
NPI:1770576225
Name:NGUYEN, HOAN C
Entity type:Individual
Prefix:
First Name:HOAN
Middle Name:C
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14411 BROOKHURST ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4667
Mailing Address - Country:US
Mailing Address - Phone:714-839-1115
Mailing Address - Fax:714-531-7936
Practice Address - Street 1:14411 BROOKHURST ST
Practice Address - Street 2:SUITE F
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4667
Practice Address - Country:US
Practice Address - Phone:714-839-1115
Practice Address - Fax:714-531-7936
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 37664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA 348450Medicaid
CA1208220001Medicare NSC