Healthcare Provider Details

I. General information

NPI: 1770851693
Provider Name (Legal Business Name): KATHY NGUYEN PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MOORPARK AVE STE 206
SAN JOSE CA
95128-2624
US

IV. Provider business mailing address

2400 MOORPARK AVE STE 206
SAN JOSE CA
95128-2624
US

V. Phone/Fax

Practice location:
  • Phone: 408-282-0500
  • Fax:
Mailing address:
  • Phone: 408-282-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH55394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: