Healthcare Provider Details

I. General information

NPI: 1558255513
Provider Name (Legal Business Name): BRIAN PHENG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 5TH ST
SAN FRANCISCO CA
94103-2919
US

IV. Provider business mailing address

1000 FRANKLIN ST APT 303
SAN FRANCISCO CA
94109-6807
US

V. Phone/Fax

Practice location:
  • Phone: 415-929-6501
  • Fax:
Mailing address:
  • Phone: 310-650-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number111588
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: