Healthcare Provider Details

I. General information

NPI: 1578787016
Provider Name (Legal Business Name): BRENT OGAWA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 12/03/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 3900 ORTHOPAEDIC DEPT
LOS ANGELES CA
90089-1004
US

IV. Provider business mailing address

8231 DELGANY AVE
PLAYA DEL REY CA
90293-7817
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-7210
  • Fax: 323-226-4051
Mailing address:
  • Phone: 323-226-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA91222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: