Healthcare Provider Details

I. General information

NPI: 1043175110
Provider Name (Legal Business Name): MINH TRI NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JOURNEY # 140A
ALISO VIEJO CA
92656-5336
US

IV. Provider business mailing address

5 JOURNEY # 140A
ALISO VIEJO CA
92656-5336
US

V. Phone/Fax

Practice location:
  • Phone: 949-669-8355
  • Fax: 949-446-4640
Mailing address:
  • Phone: 504-723-1978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: