Basic Information
| Provider Information | |||||||||
| NPI: | 1720556400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | DUC-BAO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2964 GAMBREL GATE | ||||||||
| Address2: | |||||||||
| City: | LA VERNE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917502372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097326978 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1902 ROYALTY DR STE 170 | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917673030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096209700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2018 | ||||||||
| LastUpdateDate: | 11/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 295864 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.