Healthcare Provider Details

I. General information

NPI: 1386273050
Provider Name (Legal Business Name): BRIAN MINH QUAN NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date: 05/13/2021
Reactivation Date: 06/25/2021

III. Provider practice location address

2230 LYNN RD STE 102
THOUSAND OAKS CA
91360-1920
US

IV. Provider business mailing address

2230 LYNN RD STE 102
THOUSAND OAKS CA
91360-1920
US

V. Phone/Fax

Practice location:
  • Phone: 805-495-0458
  • Fax:
Mailing address:
  • Phone: 805-495-0458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number20A25773
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number20A25773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: