1548554637 NPI number — HOA D NGUYEN

Table of content: HOA D NGUYEN (NPI 1548554637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548554637 NPI number — HOA D NGUYEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
HOA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHARMACY
Provider Other First Name:
MAILAN
Provider Other Middle Name:
HERITAGE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1548554637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14441 BEACH BLVD
Provider Second Line Business Mailing Address:
#108
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92683-5342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-899-4960
Provider Business Mailing Address Fax Number:
714-876-6011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14441 BEACH BLVD
Provider Second Line Business Practice Location Address:
#108
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92683-5342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-899-4960
Provider Business Practice Location Address Fax Number:
714-876-6011
Provider Enumeration Date:
06/06/2011

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:  40739 , 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)

  • Identifier: 1407163967 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7752910001 . This is a "MEDICARE PTAN NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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