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NPI Code Detail

MEDICARE: BRIAN KOFFMAN MD

MEDICARE: BRIAN KOFFMAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianG36410CA

General Provider Information

NPI Number : 1326049164
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN KOFFMAN MD
Provider Business Mailing Address
First Line : 1514 VALLEY VISTA DR
Second Line :
City : DIAMOND BAR
State : CA
Zip : 91765-3929
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1514 VALLEY VISTA DR
Second Line :
City : DIAMOND BAR
State : CA
Zip : 91765-3929
Country : US
Telephone Number : 909-860-1144
Fax Number : 909-860-8307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 09/19/2018

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