1215584842 NPI number — JOSEPH PHUC XUAN NGUYEN PHARMD

Table of content: JOSEPH PHUC XUAN NGUYEN PHARMD (NPI 1215584842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215584842 NPI number — JOSEPH PHUC XUAN NGUYEN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
JOSEPH
Provider Middle Name:
PHUC XUAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215584842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 RANCHO MESA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95356-8986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-613-4618
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
474 WINTON PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95334-9809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-394-6785
Provider Business Practice Location Address Fax Number:
209-394-6790
Provider Enumeration Date:
08/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  60522 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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