MEDICARE: PHUONG 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	44102	CA

General Provider Information

NPI Number	:	1992025514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHUONG NGUYEN

Provider Business Mailing Address
First Line	:	10561 KEDGE AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-5319
Country	:	US
Telephone Number	:	714-531-9447
Fax Number	:

Provider Business Practice Location Address
First Line	:	17126 VAN BUREN BLVD
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-5905
Country	:	US
Telephone Number	:	951-780-3343
Fax Number	:	951-780-6733

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

Provider Enumeration Date	:	06/05/2010
Last Update Date	:	06/05/2010

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Directions to “ PHUONG NGUYEN ” Practice Location

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