1346305166 NPI number — BRIAN L NGUYEN MD, INC

Table of content: (NPI 1346305166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346305166 NPI number — BRIAN L NGUYEN MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN L NGUYEN MD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346305166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 991
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUN CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92586-0991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-301-9339
Provider Business Mailing Address Fax Number:
951-301-3980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29798 HAUN ROAD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
SUN CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92586-6541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-301-9339
Provider Business Practice Location Address Fax Number:
951-301-3980
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
951-301-9339

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  A53427 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110219240 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DN6409 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A534271 . This is a "MEDICARE NHIC 31565 RANCHO PUEBLO STE 102 TEMECULA CA 92592" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A534271 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A534270 . This is a "31565 RANCHO PUEBLE STE 102 TEMECULA, CA 92592 MEDICARE NHIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G64785 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A534270 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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