Active NPI
Jeanny Nguyen, PHARMD
- Pharmacist
- San Carlos, CA
National Provider Identifier
1114569068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 78455
- Practice address
- 1414 El Camino Real
San Carlos, CA 94070-5102 - Phone
- (650) 637-9777
- NPI assigned
- Oct 11, 2019
- Reactivated
- Nov 19, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 78455 | CA | Primary |
Addresses
Primary practice location
1414 El Camino Real
San Carlos, CA 94070-5102
Mailing address
1414 El Camino Real
San Carlos, CA 94070-5102
Phone (650) 637-9777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78455 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609200000000",
"number": "1114569068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1414 EL CAMINO REAL",
"city": "SAN CARLOS",
"state": "CA",
"postal_code": "940705102",
"telephone_number": "650-637-9777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 EL CAMINO REAL",
"city": "SAN CARLOS",
"state": "CA",
"postal_code": "940705102",
"telephone_number": "650-637-9777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "JEANNY",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-11",
"last_updated": "2020-12-29",
"certification_date": "2020-12-29",
"deactivation_date": "2019-10-29",
"reactivation_date": "2019-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "78455",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Carlos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.