Brian Koffman, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G36410 Issued in CA

Practice address

1514 Valley Vista Dr
Diamond Bar, CA 91765-3929

Phone

(909) 860-1144

Fax

(909) 860-8307

NPI assigned

Aug 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment
• Providence Medical Foundation

  • General Practice Physician
  • Diamond Bar, CA
  • NPI 1285890624
  NPD

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1326049164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 VALLEY VISTA DR",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917653929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 VALLEY VISTA DR",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917653929",
            "telephone_number": "909-860-1144",
            "fax_number": "909-860-8307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOFFMAN",
        "first_name": "BRIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G36410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordanna Kirschner, LMFT
• Shobi Kitamura, D.C.
• Allegra Nicole Klacsmann, PH.D.
• Cleide Klassen, LCSW93624
• Katherine Ko, NP
• Sneha Kommu
• Jane Kong, M.D.
• Lesley Kongaika, PA-C
• Song Hoe Koo
• Emily Du Krasowsky, MD

• Family Medicine Physician in Diamond Bar, CA
• Providers in Diamond Bar, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.