Provider Demographics
NPI:1023351582
Name:NUYEN, BRENDA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:NUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 SANTA MONICA BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1927
Mailing Address - Country:US
Mailing Address - Phone:310-829-5475
Mailing Address - Fax:
Practice Address - Street 1:1908 SANTA MONICA BLVD
Practice Address - Street 2:STE 3
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1927
Practice Address - Country:US
Practice Address - Phone:310-829-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134069207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology