MEDICARE: KIM DUNG THI NGUYEN PHARM D

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	66672	CA

General Provider Information

NPI Number	:	1669742896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM DUNG THI NGUYEN PHARM D

Provider Business Mailing Address
First Line	:	10357 MILDRED ST
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91733-1339
Country	:	US
Telephone Number	:	626-478-7989
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 S HACIENDA BLVD
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-4240
Country	:	US
Telephone Number	:	626-333-5642
Fax Number	:

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

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	01/04/2012

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