Provider Demographics
NPI:1780916007
Name:NAGAO, BRIAN MOON YONG (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MOON YONG
Last Name:NAGAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4800 BROADWAY
Mailing Address - Street 2:SUITE 100, SACRAMENTO COUNTY CORONER
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-1540
Mailing Address - Country:US
Mailing Address - Phone:916-874-1559
Mailing Address - Fax:
Practice Address - Street 1:4800 BROADWAY
Practice Address - Street 2:SUITE 100, SACRAMENTO COUNTY CORONER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1540
Practice Address - Country:US
Practice Address - Phone:916-874-1559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 110995207ZP0102X
CAA110995207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology