Healthcare Provider Details

I. General information

NPI: 1275201030
Provider Name (Legal Business Name): ANDRE KHANG NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2021
Last Update Date: 09/05/2021
Certification Date: 09/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ROBERTSON BLVD
BEVERLY HILLS CA
90211-1788
US

IV. Provider business mailing address

321 S WILLAMAN DR APT 106
LOS ANGELES CA
90048-3340
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-3534
  • Fax:
Mailing address:
  • Phone: 559-776-8893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number84678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: