Provider Demographics
NPI:1700071669
Name:NGUYEN, BRANDON HIEN DUC HUYNH (DC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:HIEN DUC HUYNH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 W LAMARK LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-3420
Mailing Address - Country:US
Mailing Address - Phone:714-234-8322
Mailing Address - Fax:
Practice Address - Street 1:15751 ROCKFIELD BLVD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2832
Practice Address - Country:US
Practice Address - Phone:949-206-9100
Practice Address - Fax:949-206-1648
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA562677469OtherEIN
CA562677469OtherEIN