Healthcare Provider Details

I. General information

NPI: 1992209373
Provider Name (Legal Business Name): BRANDON CHUANG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD STE 400
LONG BEACH CA
90807-2008
US

IV. Provider business mailing address

4300 LONG BEACH BLVD STE 400
LONG BEACH CA
90807-2008
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-7700
  • Fax: 561-591-1311
Mailing address:
  • Phone: 562-591-7700
  • Fax: 561-591-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5296
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: