Healthcare Provider Details

I. General information

NPI: 1124983390
Provider Name (Legal Business Name): YVONNE NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16929 BUSHARD ST
FOUNTAIN VALLEY CA
92708-2819
US

IV. Provider business mailing address

19361 BROOKHURST ST SPC 81
HUNTINGTON BEACH CA
92646-2952
US

V. Phone/Fax

Practice location:
  • Phone: 714-790-0119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1400X
TaxonomyPain Management Pharmacist
License Number87819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: