Provider Demographics
NPI:1053024398
Name:NGUYEN, KEVIN MINH TRI (RPH)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MINH TRI
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 1:2600 SENTER RD SPC 101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1108
Mailing Address - Country:US
Mailing Address - Phone:408-960-5141
Mailing Address - Fax:
Practice Address - Street 1:3257 FOLSOM BLVD # 101
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5220
Practice Address - Country:US
Practice Address - Phone:916-442-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist