Provider Demographics
NPI:1306598347
Name:DINH, NAM KHOA
Entity type:Individual
Prefix:
First Name:NAM
Middle Name:KHOA
Last Name:DINH
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 1:11732 PALOMA AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2742
Mailing Address - Country:US
Mailing Address - Phone:714-722-9684
Mailing Address - Fax:
Practice Address - Street 1:5420 LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1705
Practice Address - Country:US
Practice Address - Phone:714-822-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist