Provider Demographics
NPI:1952394561
Name:NGUYEN, NHUNG C
Entity Type:Individual
Prefix:
First Name:NHUNG
Middle Name:C
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 1:9014 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5531
Mailing Address - Country:US
Mailing Address - Phone:714-890-7112
Mailing Address - Fax:714-890-7191
Practice Address - Street 1:9014 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5531
Practice Address - Country:US
Practice Address - Phone:714-890-7112
Practice Address - Fax:714-890-7191
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 38197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA 348430Medicaid
CAPHA 348430Medicaid