Healthcare Provider Details

I. General information

NPI: 1366278368
Provider Name (Legal Business Name): AILYNN BAC NGUYEN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 CITY PKWY W
ORANGE CA
92868-2924
US

IV. Provider business mailing address

505 CITY PKWY W
ORANGE CA
92868-2924
US

V. Phone/Fax

Practice location:
  • Phone: 916-490-6233
  • Fax: 714-796-6649
Mailing address:
  • Phone: 916-490-6233
  • Fax: 714-796-6649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number90125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: