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General NPI Number Information
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NPI Number | 1003108291
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Entity Type | Organization
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Legal Business Name | BRIAN K MACHIDA MD A MEDICAL CORP
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 1250 S SUNSET AVE #206
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City | WEST COVINA
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State | CA
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Zip | 91790-3961
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Country | US
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Telephone | 626-338-4453
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Fax | 626-338-2556
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Provider Business Mailing Address
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Address Line | 1250 S SUNSET AVE #206
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City | WEST COVINA
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State | CA
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Zip | 91790-3961
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Country | US
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Telephone | 626-338-4453
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Fax | 626-338-2556
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. BRIAN K MACHIDA
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Credential | M.D
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Telephone | 626-338-4453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | G52616
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License Number State | CA
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