Healthcare Provider Details

I. General information

NPI: 1407296932
Provider Name (Legal Business Name): BRANDON DAVID BRIGHT LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 02/10/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6324 E PACIFIC COAST HWY STE C
LONG BEACH CA
90803-4841
US

IV. Provider business mailing address

434 LENWOOD DR
COSTA MESA CA
92627-3215
US

V. Phone/Fax

Practice location:
  • Phone: 562-493-5600
  • Fax:
Mailing address:
  • Phone: 714-206-7883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: