Healthcare Provider Details

I. General information

NPI: 1447108022
Provider Name (Legal Business Name): VINCENT MAI NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 N MAIN ST
WALNUT CREEK CA
94596-4106
US

IV. Provider business mailing address

8007 COMANCHE AVE
WINNETKA CA
91306-1831
US

V. Phone/Fax

Practice location:
  • Phone: 818-687-8583
  • Fax:
Mailing address:
  • Phone: 818-687-8583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: