Provider Demographics
NPI:1548554637
Name:NGUYEN, HOA D
Entity type:Individual
Prefix:
First Name:HOA
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MAILAN
Other - Middle Name:HERITAGE
Other - Last Name:PHARMACY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14441 BEACH BLVD
Mailing Address - Street 2:#108
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5342
Mailing Address - Country:US
Mailing Address - Phone:714-899-4960
Mailing Address - Fax:714-876-6011
Practice Address - Street 1:14441 BEACH BLVD
Practice Address - Street 2:#108
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5342
Practice Address - Country:US
Practice Address - Phone:714-899-4960
Practice Address - Fax:714-876-6011
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407163967Medicaid
CA7752910001OtherMEDICARE PTAN NUMBER