Provider Demographics
NPI:1811430689
Name:NGUYEN, JENNIFER
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
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 1:241 OCEAN VIEW AVE APT I
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2657
Mailing Address - Country:US
Mailing Address - Phone:714-461-1689
Mailing Address - Fax:
Practice Address - Street 1:241 OCEAN VIEW AVE APT I
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2657
Practice Address - Country:US
Practice Address - Phone:714-461-1689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist