Healthcare Provider Details

I. General information

NPI: 1306128467
Provider Name (Legal Business Name): KIM TIEN NGUYEN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 KEHALANI VILLAGE DR
WAILUKU HI
96793-2197
US

IV. Provider business mailing address

135 KEHALANI VILLAGE DR
WAILUKU HI
96793-2197
US

V. Phone/Fax

Practice location:
  • Phone: 808-242-5606
  • Fax:
Mailing address:
  • Phone: 808-242-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-3461
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: