Provider Demographics
NPI:1447817317
Name:NGUYEN, LAM N
Entity type:Individual
Prefix:
First Name:LAM
Middle Name:N
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LAM
Other - Middle Name:N
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2538 N HESPERIAN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-1434
Mailing Address - Country:US
Mailing Address - Phone:714-467-7600
Mailing Address - Fax:
Practice Address - Street 1:21761 LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2784
Practice Address - Country:US
Practice Address - Phone:949-855-8307
Practice Address - Fax:949-855-9564
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist