MEDICARE: DR. BRIAN NGUYEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401414571	VA
2	122300000X	Dentist	64309	CA

General Provider Information

NPI Number	:	1134538804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN NGUYEN

Provider Business Mailing Address
First Line	:	2213 W KNOX AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-5542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16903 BEACH BLVD
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4808
Country	:	US
Telephone Number	:	714-379-6248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	12/20/2018

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