Provider Demographics
NPI:1417012949
Name:MACHIDA, BRIAN K (MD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:K
Last Name:MACHIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 ONTARIO MILLS PKY
Mailing Address - Street 2:STE 107
Mailing Address - City:PNTARIIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764
Mailing Address - Country:US
Mailing Address - Phone:909-476-2600
Mailing Address - Fax:909-476-2636
Practice Address - Street 1:4550 ONTARIO MILLS PKY
Practice Address - Street 2:STE 107
Practice Address - City:PNTARIIO
Practice Address - State:CA
Practice Address - Zip Code:91764
Practice Address - Country:US
Practice Address - Phone:909-476-2600
Practice Address - Fax:909-476-2636
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA652616174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G526160Medicaid
CAG52616Medicare ID - Type Unspecified
CA00G526160Medicaid