Healthcare Provider Details

I. General information

NPI: 1619813508
Provider Name (Legal Business Name): KIM NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S WESTERN AVE STE 1F181
OKLAHOMA CITY OK
73109-3413
US

IV. Provider business mailing address

4813 WELLMAN WAY
NORMAN OK
73072-3700
US

V. Phone/Fax

Practice location:
  • Phone: 405-231-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15778
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: