Healthcare Provider Details

I. General information

NPI: 1336795285
Provider Name (Legal Business Name): MAI NGUYEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S EUCLID ST
ANAHEIM CA
92802-1011
US

IV. Provider business mailing address

17699 SAN DIEGO CIR
FOUNTAIN VALLEY CA
92708-5243
US

V. Phone/Fax

Practice location:
  • Phone: 714-422-1121
  • Fax:
Mailing address:
  • Phone: 714-614-1772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MAI NGUYEN
Title or Position: PHARMACIST
Credential:
Phone: 714-614-1772