Provider Demographics
NPI:1972327005
Name:NGUYEN, BRANDON THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:THOMAS
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 GREENPARK WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2128
Mailing Address - Country:US
Mailing Address - Phone:408-832-1566
Mailing Address - Fax:
Practice Address - Street 1:1901 MONTEREY RD
Practice Address - Street 2:STE 10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112
Practice Address - Country:US
Practice Address - Phone:408-477-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant