Healthcare Provider Details

I. General information

NPI: 1407771249
Provider Name (Legal Business Name): MICHELLE THIEN-KIM NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 HARBOR BLVD
COSTA MESA CA
92626-1437
US

IV. Provider business mailing address

15213 SEVERYNS RD
TUSTIN CA
92782-1797
US

V. Phone/Fax

Practice location:
  • Phone: 877-445-6874
  • Fax:
Mailing address:
  • Phone: 949-880-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number32333
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: