Healthcare Provider Details

I. General information

NPI: 1124023759
Provider Name (Legal Business Name): CHARLES VICTOR BROWN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 W GARDENA BLVD STE 102
GARDENA CA
90247-4884
US

IV. Provider business mailing address

PO BOX 84524
LOS ANGELES CA
90073-0524
US

V. Phone/Fax

Practice location:
  • Phone: 310-538-0400
  • Fax:
Mailing address:
  • Phone: 310-696-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberA49923
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA49923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: