=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861688061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMARPREET S BRAR MD INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2007
-----------------------------------------------------
Last Update Date | 09/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1045 W REDONDO BEACH BLVD STE 400
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90247-4180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-219-7701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1045 W REDONDO BEACH BLVD STE 400
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90247-4180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-219-7701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMARPREET BRAR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-219-7701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | A77993
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------