Provider Demographics
NPI:1811282965
Name:NGUYEN, MAI NHU
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:NHU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 W MC KINLEY AVE
Mailing Address - Street 2:T2584
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-6193
Mailing Address - Country:US
Mailing Address - Phone:408-702-1013
Mailing Address - Fax:408-702-1021
Practice Address - Street 1:298 W MC KINLEY AVE
Practice Address - Street 2:T2584
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6193
Practice Address - Country:US
Practice Address - Phone:408-702-1013
Practice Address - Fax:408-702-1021
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist