Provider Demographics
NPI:1356361109
Name:BRAR, AMARPREET
Entity type:Individual
Prefix:
First Name:AMARPREET
Middle Name:
Last Name:BRAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 W REDONDO BEACH BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4180
Mailing Address - Country:US
Mailing Address - Phone:310-219-7701
Mailing Address - Fax:
Practice Address - Street 1:1045 W REDONDO BEACH BLVD STE 400
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4180
Practice Address - Country:US
Practice Address - Phone:310-219-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77993207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A779930Medicaid
CAH47679Medicare UPIN
CAWA77993BMedicare PIN