Healthcare Provider Details

I. General information

NPI: 1356687354
Provider Name (Legal Business Name): BRILLIANT CORNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 FOLSOM ST
SAN FRANCISCO CA
94107-1123
US

IV. Provider business mailing address

854 FOLSOM ST
SAN FRANCISCO CA
94107-1123
US

V. Phone/Fax

Practice location:
  • Phone: 415-618-0012
  • Fax:
Mailing address:
  • Phone: 415-618-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: TYLER FONG
Title or Position: DEPUTY CHIEF OPERATING OFFICER
Credential:
Phone: 415-618-0012