Healthcare Provider Details

I. General information

NPI: 1376077115
Provider Name (Legal Business Name): KATE NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27303 SLEEPY HOLLOW AVE S
HAYWARD CA
94545-4203
US

IV. Provider business mailing address

3600 BROADWAY
OAKLAND CA
94611-5730
US

V. Phone/Fax

Practice location:
  • Phone: 510-784-4589
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number72573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: