MEDICARE: BRANDON T. NGUYEN, DMD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	47973	CA

General Provider Information

NPI Number	:	1346451762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDON T. NGUYEN, DMD, INC.

Provider Business Mailing Address
First Line	:	1360 E ANAHEIM ST
Second Line	:	SUITE 109
City	:	LONG BEACH
State	:	CA
Zip	:	90813-5514
Country	:	US
Telephone Number	:	562-599-3838
Fax Number	:	562-599-6818

Provider Business Practice Location Address
First Line	:	1360 E ANAHEIM ST
Second Line	:	SUITE 109
City	:	LONG BEACH
State	:	CA
Zip	:	90813-5514
Country	:	US
Telephone Number	:	562-599-3838
Fax Number	:	562-599-6818

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRANDON T NGUYEN
Credential	:	DMD
Telephone Number	:	562-599-3838

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	08/22/2020

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