Healthcare Provider Details

I. General information

NPI: 1679933535
Provider Name (Legal Business Name): DAVID TRIEU NGUYEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 JENSEN AVE STE 101
SANGER CA
93657-2248
US

IV. Provider business mailing address

2407 JENSEN AVE SUITE 101
SANGER CA
93657-2248
US

V. Phone/Fax

Practice location:
  • Phone: 559-399-8644
  • Fax: 559-399-8643
Mailing address:
  • Phone: 559-399-8644
  • Fax: 559-399-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY54339
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BA HUYNH
Title or Position: MANAGER
Credential:
Phone: 559-940-4186