=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366633182
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TUAN BRIAN NGUYEN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2007
-----------------------------------------------------
Last Update Date | 03/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2031 N. BUFFALO DR.
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-383-3750
-----------------------------------------------------
Fax | 702-256-3231
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2031 N. BUFFALO DR.
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-383-3750
-----------------------------------------------------
Fax | 702-256-3231
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD.202631
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------