Provider Demographics
NPI:1710943527
Name:RUDIN, BRIAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DAVID
Last Name:RUDIN
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 1:1014 S WESTLAKE BLVD
Mailing Address - Street 2:SUITE 14, PMB# 171
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3108
Mailing Address - Country:US
Mailing Address - Phone:805-285-2225
Mailing Address - Fax:805-285-3291
Practice Address - Street 1:696 HAMPSHIRE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2699
Practice Address - Country:US
Practice Address - Phone:805-285-2225
Practice Address - Fax:805-285-3291
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75433207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA75433EMedicare PIN
CAWA75433BMedicare PIN
CA0878110001Medicare NSC
CAWA75433CMedicare PIN
CAI13924Medicare UPIN
CAWA75433DMedicare PIN
CAW268AMedicare PIN
CAW268Medicare PIN
CAW268EMedicare PIN