Healthcare Provider Details

I. General information

NPI: 1902281199
Provider Name (Legal Business Name): VAN NGUYEN PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 OAKLAND AVE
OAKLAND CA
94611-4567
US

IV. Provider business mailing address

1130 3RD AVE APT 908
OAKLAND CA
94606-2258
US

V. Phone/Fax

Practice location:
  • Phone: 510-671-0908
  • Fax:
Mailing address:
  • Phone: 408-693-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number76327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: