Healthcare Provider Details

I. General information

NPI: 1053481663
Provider Name (Legal Business Name): BRANDON TUAN THAI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28100 BOUQUET CANYON RD 200
SAUGUS CA
91350-2006
US

IV. Provider business mailing address

28100 BOUQUET CANYON RD 200
SAUGUS CA
91350-2006
US

V. Phone/Fax

Practice location:
  • Phone: 661-263-6923
  • Fax: 661-263-9776
Mailing address:
  • Phone: 661-263-6923
  • Fax: 661-263-9776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number49227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: