Healthcare Provider Details

I. General information

NPI: 1346682804
Provider Name (Legal Business Name): BRIAN FUMIO MAYEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 TORRANCE BLVD
TORRANCE CA
90503-4009
US

IV. Provider business mailing address

601 BROADWAY FL 6
SEATTLE WA
98122-5330
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-6190
  • Fax:
Mailing address:
  • Phone: 206-386-2600
  • Fax: 206-622-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD60956312
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD60956312
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA133834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: