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General NPI Number Information
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NPI Number | 1609401132
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Entity Type | Individual
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Provider Name | BRYAN MINH DO DDS
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Gender | Male
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Dates
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Enumeration Date | 03/05/2020
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 3408 COLLEGE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92115-7134
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Country | US
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Telephone | 619-363-3881
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 PASEO VILLAGE WAY APT 2538
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City | SAN DIEGO
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State | CA
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Zip | 92130-3267
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Country | US
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Telephone | 714-580-4410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DDS106572
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License Number State | CA
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