MEDICARE: BRYAN DAVID HUBBARD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	G079530	CA
2	2086S0127X	Trauma Surgery Physician	MD600003711	DC

General Provider Information

NPI Number	:	1447305438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN DAVID HUBBARD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1304
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-0304
Country	:	US
Telephone Number	:	213-673-1478
Fax Number	:	310-347-4318

Provider Business Practice Location Address
First Line	:	1513 S GRAND AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3070
Country	:	US
Telephone Number	:	213-673-1478
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	10/13/2025

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