MEDICARE: VAN NGUYEN

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	44891	CA

General Provider Information

NPI Number	:	1639587041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VAN NGUYEN

Provider Business Mailing Address
First Line	:	151 E 5TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-2489
Country	:	US
Telephone Number	:	562-436-0560
Fax Number	:	562-436-2592

Provider Business Practice Location Address
First Line	:	151 E 5TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-2489
Country	:	US
Telephone Number	:	562-436-0560
Fax Number	:	562-436-2592

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

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	07/29/2014

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Directions to “ VAN NGUYEN ” Practice Location

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