Healthcare Provider Details

I. General information

NPI: 1154205029
Provider Name (Legal Business Name): BRIAN NGUYEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MEDICAL CENTER RD
FT HOOD TX
76544-5060
US

IV. Provider business mailing address

9900 LINCOLN ST 2ND FLOOR
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 714-860-3358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: