Provider Demographics
NPI:1851314512
Name:NGUYEN, BRIAN LINH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2051
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-1051
Mailing Address - Country:US
Mailing Address - Phone:951-301-9339
Mailing Address - Fax:951-301-3980
Practice Address - Street 1:29798 HAUN RD
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A534271Medicaid
110219240OtherRAILROAD MEDICARE
CA00A534270Medicaid
CAG64785Medicare UPIN
CA00A534270Medicare PIN
110219240OtherRAILROAD MEDICARE