Healthcare Provider Details

I. General information

NPI: 1992099345
Provider Name (Legal Business Name): KHANH NGUYEN PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PETER NGUYEN PHARM.D

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26762 PORTOLA PKWY
FOOTHILL RANCH CA
92610-1712
US

IV. Provider business mailing address

26762 PORTOLA PKWY
FOOTHILL RANCH CA
92610-1712
US

V. Phone/Fax

Practice location:
  • Phone: 949-454-0327
  • Fax: 949-454-0327
Mailing address:
  • Phone: 949-454-0327
  • Fax: 949-454-0327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: