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General NPI Number Information
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NPI Number | 1619568391
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Entity Type | Individual
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Provider Name | KEVIN ANH VU LE NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 200 FREEDOM LN
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5876
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Country | US
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Telephone | 949-900-8437
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Fax |
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Provider Business Mailing Address
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Address Line | 1163 E LITTLE DR
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City | PLACENTIA
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State | CA
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Zip | 92870-5268
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Country | US
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Telephone | 714-616-6954
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 83968
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License Number State | CA
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