Provider Demographics
NPI:1770114399
Name:NGHIEM, JOHN QUANG (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:QUANG
Last Name:NGHIEM
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 1:500 E WILKEN WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-4946
Mailing Address - Country:US
Mailing Address - Phone:714-313-2623
Mailing Address - Fax:
Practice Address - Street 1:22361 ANTONIO PKWY
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2809
Practice Address - Country:US
Practice Address - Phone:949-888-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist