MEDICARE: CAM NHUNG PHUOC 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	50082	CA

General Provider Information

NPI Number	:	1831756592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAM NHUNG PHUOC NGUYEN

Provider Business Mailing Address
First Line	:	3951 CARRACCI LN
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1732
Country	:	US
Telephone Number	:	408-528-7326
Fax Number	:

Provider Business Practice Location Address
First Line	:	4850 SAN FELIPE RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1266
Country	:	US
Telephone Number	:	408-532-2952
Fax Number	:	408-532-9464

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

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	05/28/2019

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