Healthcare Provider Details

I. General information

NPI: 1295482826
Provider Name (Legal Business Name): BRANDON HONG CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23206 LYONS AVE STE 111
SANTA CLARITA CA
91321-2671
US

IV. Provider business mailing address

23206 LYONS AVE STE 111
SANTA CLARITA CA
91321-2671
US

V. Phone/Fax

Practice location:
  • Phone: 661-753-9260
  • Fax: 661-753-9337
Mailing address:
  • Phone: 661-753-9260
  • Fax: 661-753-9337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO04850
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO04850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: