Healthcare Provider Details

I. General information

NPI: 1780916007
Provider Name (Legal Business Name): BRIAN MOON YONG NAGAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 BROADWAY SUITE 100, SACRAMENTO COUNTY CORONER
SACRAMENTO CA
95820-1540
US

IV. Provider business mailing address

4800 BROADWAY SUITE 100, SACRAMENTO COUNTY CORONER
SACRAMENTO CA
95820-1540
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-1559
  • Fax:
Mailing address:
  • Phone: 916-874-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberA110995
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA 110995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: