Healthcare Provider Details

I. General information

NPI: 1003108291
Provider Name (Legal Business Name): BRIAN K MACHIDA MD A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S SUNSET AVE #206
WEST COVINA CA
91790-3961
US

IV. Provider business mailing address

1250 S SUNSET AVE #206
WEST COVINA CA
91790-3961
US

V. Phone/Fax

Practice location:
  • Phone: 626-338-4453
  • Fax: 626-338-2556
Mailing address:
  • Phone: 626-338-4453
  • Fax: 626-338-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberG52616
License Number StateCA

VIII. Authorized Official

Name: DR. BRIAN K MACHIDA
Title or Position: DOCTOR
Credential: M.D
Phone: 626-338-4453