MEDICARE: JENNY KIM NGUYEN 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	RPH57563	CA

General Provider Information

NPI Number	:	1417266115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY KIM NGUYEN PHARM.D

Provider Business Mailing Address
First Line	:	17305 ARDATH AVE
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-2911
Country	:	US
Telephone Number	:	310-408-7713
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 AVIATION BLVD
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-2810
Country	:	US
Telephone Number	:	310-376-4460
Fax Number	:

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

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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