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General NPI Number Information
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NPI Number | 1831753342
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Entity Type | Individual
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Provider Name | LOAN NGOC NGUYEN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 4110 N 1ST ST
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City | SAN JOSE
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State | CA
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Zip | 95134-1513
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Country | US
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Telephone | 404-434-1839
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Fax |
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Provider Business Mailing Address
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Address Line | 3121 DIABLO AVE
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City | HAYWARD
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State | CA
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Zip | 94545-2701
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Country | US
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Telephone |
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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 | 62509
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License Number State | CA
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