Provider Demographics
NPI:1396908968
Name:NGUYEN, KEVIN K (RPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:K
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 W ROME AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3927
Mailing Address - Country:US
Mailing Address - Phone:562-425-2713
Mailing Address - Fax:562-425-9713
Practice Address - Street 1:6400 E SPRING ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1553
Practice Address - Country:US
Practice Address - Phone:562-425-2713
Practice Address - Fax:562-425-9713
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist