Healthcare Provider Details

I. General information

NPI: 1952398992
Provider Name (Legal Business Name): NGUYEN KIM CHIEM R PH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9246 VALLEY BLVD STE B
ROSEMEAD CA
91770-1922
US

IV. Provider business mailing address

9246 VALLEY BLVD STE B
ROSEMEAD CA
91770-1922
US

V. Phone/Fax

Practice location:
  • Phone: 626-280-3985
  • Fax: 626-280-5839
Mailing address:
  • Phone: 626-280-3985
  • Fax: 626-280-5839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH41766
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA36078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: