Provider Demographics
NPI:1346305166
Name:BRIAN L NGUYEN MD, INC
Entity Type:Organization
Organization Name:BRIAN L NGUYEN MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-301-9339
Mailing Address - Street 1:PO BOX 991
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-0991
Mailing Address - Country:US
Mailing Address - Phone:951-301-9339
Mailing Address - Fax:951-301-3980
Practice Address - Street 1:29798 HAUN ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-6541
Practice Address - Country:US
Practice Address - Phone:951-301-9339
Practice Address - Fax:951-301-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53427207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110219240OtherRAILROAD MEDICARE
CADN6409OtherRAILROAD MEDICARE
CA00A534271OtherMEDICARE NHIC 31565 RANCHO PUEBLO STE 102 TEMECULA CA 92592
CA00A534271Medicaid
CA00A534270Other31565 RANCHO PUEBLE STE 102 TEMECULA, CA 92592 MEDICARE NHIC
CAG64785Medicaid
CA00A534270Medicaid
CAG64785Medicaid
CA00A534271Medicaid
CA00A534271OtherMEDICARE NHIC 31565 RANCHO PUEBLO STE 102 TEMECULA CA 92592
CAG64785Medicare UPIN
CA00A534270Medicare ID - Type Unspecified44274 GEORGE CUSHMAN TEME