Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 59840 | CA |
Y | 213EG0000X | General Practice | 59840 | CA |
NPI | 1003125204 |
---|---|
Provider Name | Dr. Bryant Dang-Khoa Nguyen |
First Address | Aliso Viejo, CA 92656-1430 |
Second Address | Aliso Viejo, CA 92656-1430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2010 |
Last Update Date | 05/10/2010 |