Healthcare Provider Details

I. General information

NPI: 1356133516
Provider Name (Legal Business Name): DAVID SON PHAM HOANG NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

1581 W 29TH ST
LOS ANGELES CA
90007-2851
US

V. Phone/Fax

Practice location:
  • Phone: 213-738-4725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89945
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number89945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: