Healthcare Provider Details

I. General information

NPI: 1710899000
Provider Name (Legal Business Name): BINH TAN NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8554 SIERRA AVE
FONTANA CA
92335-3840
US

IV. Provider business mailing address

8554 SIERRA AVE
FONTANA CA
92335-3840
US

V. Phone/Fax

Practice location:
  • Phone: 909-822-2288
  • Fax: 909-822-2113
Mailing address:
  • Phone: 909-822-2288
  • Fax: 909-822-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: