Individual provider Active NPI

Bradley William Dea

  • Physician Assistant
  • Alhambra, CA
National Provider Identifier
1205546991
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1000 S Fremont Ave Unit 7
Alhambra, CA 91803-8897
Phone
(626) 457-4254
Fax
(626) 457-4245
NPI assigned
Dec 2, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X CA Primary

Addresses

Primary practice location

1000 S Fremont Ave Unit 7
Alhambra, CA 91803-8897

Mailing address

1137 Ridgeside Dr
Monterey Park, CA 91754-3730
Phone (626) 665-3648

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL 6266653648 Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251211003179 CA Practitioner - Physician Assistant 9133613656 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
May accept Medicare assignment
Group practices
California Wound Healing Medical Group Inc.Group PAC ID 7315033198, 21 clinicians

Practice addresses (Care Compare)

100 E Huntington Dr
Alhambra, CA 91801-1022
Phone (323) 264-7796

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
66863CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Healing Edge Medical Group - Ca CurrentSince Dec 9, 2025 Accepting new patients
California Wound Healing Medical Group Inc. CurrentSince Oct 29, 2025 Accepting new patients
New Hope Podiatry Group Inc. PastSince Dec 29, 2024 Accepting new patients

Locations

100 E Huntington Dr
Ste 209
Alhambra, CA 91801
Phone (323) 262-4146

100 E Huntington Dr
Ste 203
Alhambra, CA 91801

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1205546991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 RIDGESIDE DR",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917543730",
            "telephone_number": "626-665-3648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S FREMONT AVE UNIT 7",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918038897",
            "telephone_number": "626-457-4254",
            "fax_number": "626-457-4245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEA",
        "first_name": "BRADLEY",
        "middle_name": "WILLIAM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-12-02",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "6266653648",
            "affiliation": "N",
            "endpointDescription": "fax",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "N/A",
            "address_1": "1000 S Fremont Ave Unit 7",
            "city": "Alhambra",
            "state": "CA",
            "country_code": "US",
            "postal_code": "918038897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Alhambra, CA

Sources for this page

Verify at the official NPI Registry.