Provider Demographics
NPI:1932734373
Name:HOANG, KIM NGUYEN (RPH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:NGUYEN
Last Name:HOANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32900 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3464
Mailing Address - Country:US
Mailing Address - Phone:949-489-9030
Mailing Address - Fax:
Practice Address - Street 1:32900 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3464
Practice Address - Country:US
Practice Address - Phone:949-489-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA056575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist