Provider Demographics
NPI:1952398992
Name:CHIEM, NGUYEN KIM (R PH)
Entity type:Individual
Prefix:
First Name:NGUYEN
Middle Name:KIM
Last Name:CHIEM
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9246 VALLEY BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1922
Mailing Address - Country:US
Mailing Address - Phone:626-280-3985
Mailing Address - Fax:626-280-5839
Practice Address - Street 1:9246 VALLEY BLVD
Practice Address - Street 2:STE B
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1922
Practice Address - Country:US
Practice Address - Phone:626-280-3985
Practice Address - Fax:626-280-5839
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH41766183500000X
CAPHA36078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA360780Medicaid