Healthcare Provider Details

I. General information

NPI: 1184144248
Provider Name (Legal Business Name): BRIAN GOO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 E GREEN ST
PASADENA CA
91106-2505
US

IV. Provider business mailing address

1145 E GREEN ST
PASADENA CA
91106-2505
US

V. Phone/Fax

Practice location:
  • Phone: 626-421-7787
  • Fax: 626-421-7782
Mailing address:
  • Phone: 626-421-7787
  • Fax: 626-421-7782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number101435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: