Healthcare Provider Details

I. General information

NPI: 1962056366
Provider Name (Legal Business Name): KHIEM DINH NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 N IMPERIAL AVE STE K
EL CENTRO CA
92243-1320
US

IV. Provider business mailing address

1699 N IMPERIAL AVE STE K
EL CENTRO CA
92243-1320
US

V. Phone/Fax

Practice location:
  • Phone: 360-521-0978
  • Fax:
Mailing address:
  • Phone: 360-521-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH80674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: