Healthcare Provider Details

I. General information

NPI: 1508882564
Provider Name (Legal Business Name): BRANDON SON TRUONG NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRANDON SON TRUONG NGUYEN D.O.

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 VAN NESS AVE STE 402
SAN FRANCISCO CA
94109-3019
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-1219
  • Fax:
Mailing address:
  • Phone: 415-567-1219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberTL1006
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A9059
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberTL1006
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberT2230
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number20A9059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: