Healthcare Provider Details

I. General information

NPI: 1346912441
Provider Name (Legal Business Name): PATRICK KIM NGUYEN HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5866 MOWRY SCHOOL RD
NEWARK CA
94560-5367
US

IV. Provider business mailing address

5886 MOWRY SCHOOL RD
NEWARK CA
94560-5367
US

V. Phone/Fax

Practice location:
  • Phone: 510-573-0064
  • Fax: 510-573-0096
Mailing address:
  • Phone: 510-573-0064
  • Fax: 510-573-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: