Active NPI
Derek Tri Van Nguyen, PHARMD
- Pharmacist
- San Rafael, CA
National Provider Identifier
1831709765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 82689
- Practice address
- 100 Smith Ranch Rd FL 2
San Rafael, CA 94903-5552 - Phone
- (415) 541-6383
- NPI assigned
- Aug 5, 2020
- Sex
- Male
- Sole proprietor
- No
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 | 82689 | CA | Primary |
Addresses
Primary practice location
100 Smith Ranch Rd FL 2
San Rafael, CA 94903-5552
Mailing address
420 Canal St Apt 1
San Rafael, CA 94901-4136
Phone (714) 457-9936
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 |
|---|---|---|---|
| 82689 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596585600000",
"number": "1831709765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 CANAL ST APT 1",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949014136",
"telephone_number": "714-457-9936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 SMITH RANCH RD FL 2",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949035552",
"telephone_number": "415-541-6383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "DEREK",
"middle_name": "TRI VAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-05",
"last_updated": "2020-08-05",
"certification_date": "2020-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "82689",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.