Provider Demographics
NPI:1316214083
Name:NGUYEN, KIM CHI THI (PHARMD)
Entity type:Individual
Prefix:
First Name:KIM CHI
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 BIRD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-1700
Mailing Address - Country:US
Mailing Address - Phone:408-295-7768
Mailing Address - Fax:
Practice Address - Street 1:1130 BIRD AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-1700
Practice Address - Country:US
Practice Address - Phone:408-295-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-24
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist