Healthcare Provider Details

I. General information

NPI: 1447563895
Provider Name (Legal Business Name): MR. JASON BAO NGHIEM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. THUY BAO NGHIEM

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 E AVENUE S
PALMDALE CA
93550-6202
US

IV. Provider business mailing address

41463 ALEXO DR
LANCASTER CA
93536-2333
US

V. Phone/Fax

Practice location:
  • Phone: 661-274-4333
  • Fax: 661-274-8015
Mailing address:
  • Phone: 714-932-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: