1346305166 NPI number — BRIAN L NGUYEN MD, INC

Table of Contents

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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