Healthcare Provider Details

I. General information

NPI: 1174458905
Provider Name (Legal Business Name): HOANG TRUC NGUYEN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16995 WALNUT GROVE DR
MORGAN HILL CA
95037-4440
US

IV. Provider business mailing address

3582 CLAYTON RD
SAN JOSE CA
95127-4911
US

V. Phone/Fax

Practice location:
  • Phone: 408-779-6981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number92445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: