MEDICARE: LIN NAM VONG PHARM D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	57074	CA

General Provider Information

NPI Number	:	1033419759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIN NAM VONG PHARM D.

Provider Business Mailing Address
First Line	:	3034 RIDGEGATE DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95133-1458
Country	:	US
Telephone Number	:	408-729-4535
Fax Number	:

Provider Business Practice Location Address
First Line	:	785 E EL CAMINO REAL
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-2919
Country	:	US
Telephone Number	:	408-481-3302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	10/27/2010

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Directions to “ LIN NAM VONG PHARM D.” Practice Location

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