Provider Demographics
NPI:1992099345
Name:NGUYEN, KHANH (PHARMD)
Entity type:Individual
Prefix:
First Name:KHANH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:26762 PORTOLA PKWY
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1712
Mailing Address - Country:US
Mailing Address - Phone:949-454-0327
Mailing Address - Fax:949-454-0327
Practice Address - Street 1:26762 PORTOLA PKWY
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-1712
Practice Address - Country:US
Practice Address - Phone:949-454-0327
Practice Address - Fax:949-454-0327
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist