Healthcare Provider Details

I. General information

NPI: 1346451762
Provider Name (Legal Business Name): BRANDON T. NGUYEN, DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 E ANAHEIM ST SUITE 109
LONG BEACH CA
90813-5514
US

IV. Provider business mailing address

1360 E ANAHEIM ST SUITE 109
LONG BEACH CA
90813-5514
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-3838
  • Fax: 562-599-6818
Mailing address:
  • Phone: 562-599-3838
  • Fax: 562-599-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number47973
License Number StateCA

VIII. Authorized Official

Name: DR. BRANDON T NGUYEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 562-599-3838