Provider Demographics
NPI:1700403979
Name:NGUYEN, BRIAN M (LAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 1/2 W CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2199
Mailing Address - Country:US
Mailing Address - Phone:213-268-2418
Mailing Address - Fax:
Practice Address - Street 1:429 1/2 W CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2199
Practice Address - Country:US
Practice Address - Phone:213-268-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18451171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist