Provider Demographics
NPI:1720617186
Name:NGUYEN, BRYAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16690 MOUNT ACOMA CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2429
Mailing Address - Country:US
Mailing Address - Phone:714-553-4531
Mailing Address - Fax:
Practice Address - Street 1:22995 MILL CREEK DR STE A
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1271
Practice Address - Country:US
Practice Address - Phone:949-707-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT297989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist