Provider Demographics
NPI:1972969947
Name:NGHIEM, HAN NGOC
Entity type:Individual
Prefix:
First Name:HAN
Middle Name:NGOC
Last Name:NGHIEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2604
Mailing Address - Country:US
Mailing Address - Phone:310-517-9535
Mailing Address - Fax:
Practice Address - Street 1:2001 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2604
Practice Address - Country:US
Practice Address - Phone:310-517-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist