Provider Demographics
NPI:1063285740
Name:NGUYEN, KELVIN
Entity type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11348 E SOLINA CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-7038
Mailing Address - Country:US
Mailing Address - Phone:480-522-0827
Mailing Address - Fax:
Practice Address - Street 1:4316 S SIGNAL BUTTE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-4214
Practice Address - Country:US
Practice Address - Phone:480-296-7955
Practice Address - Fax:480-296-7954
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist