MEDICARE: KEVIN NGUYEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	60450	CA

General Provider Information

NPI Number	:	1124313606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN NGUYEN

Provider Business Mailing Address
First Line	:	4751 LAKESHORE DR
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-1368
Country	:	US
Telephone Number	:	408-892-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 COCHRANE RD
Second Line	:
City	:	MORGAN HILL
State	:	CA
Zip	:	95037-9305
Country	:	US
Telephone Number	:	408-310-4051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	06/13/2011

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