Provider Demographics
NPI:1508882564
Name:NGUYEN, BRANDON SON TRUONG (DO)
Entity Type:Individual
Prefix:DR
First Name:BRANDON SON
Middle Name:TRUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:BRANDON SON
Other - Middle Name:TRUONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-567-1219
Mailing Address - Fax:
Practice Address - Street 1:2000 VAN NESS AVE STE 402
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-3019
Practice Address - Country:US
Practice Address - Phone:415-567-1219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVTL1006207L00000X, 207LP2900X
CA20A9059207L00000X, 208VP0014X
TXT2230208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400014985Medicare PIN
CAI33794Medicare UPIN
CAAM937YMedicare PIN