Provider Demographics
NPI:1003108291
Name:BRIAN K MACHIDA MD A MEDICAL CORP
Entity Type:Organization
Organization Name:BRIAN K MACHIDA MD A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MACHIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-338-4453
Mailing Address - Street 1:1250 S SUNSET AVE
Mailing Address - Street 2:#206
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3961
Mailing Address - Country:US
Mailing Address - Phone:626-338-4453
Mailing Address - Fax:626-338-2556
Practice Address - Street 1:1250 S SUNSET AVE
Practice Address - Street 2:#206
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3961
Practice Address - Country:US
Practice Address - Phone:626-338-4453
Practice Address - Fax:626-338-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52616207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG52616Medicare UPIN
CAE02702Medicare UPIN