Brandon Kenneth Lawrence

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

14275122 Issued in CA

Practice address

Grandview Medical-Dental Clinic (GMDC) 1000 Wallace Way
Grandview, WA 98930

Phone

(509) 788-1702

Fax

(509) 786-1022

NPI assigned

Mar 27, 2024

Sex

Male

Sole proprietor

Yes

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 WA

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

State licenses

Interoperability endpoints

• Direct secure messaging: blawrence44233@yvfwc.direct-ci.com

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

{
    "created_epoch": "1711497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1396596417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22436 BIRDS EYE DR",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917652405",
            "telephone_number": "190-986-1048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "GRANDVIEW MEDICAL-DENTAL CLINIC (GMDC) 1000 WALLACE WAY",
            "city": "GRANDVIEW",
            "state": "WA",
            "postal_code": "98930",
            "telephone_number": "509-788-1702",
            "fax_number": "509-786-1022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22436 Birds Eye Dr",
            "address_purpose": "LOCATION",
            "city": "Diamond Bar",
            "state": "CA",
            "postal_code": "917652405",
            "country_code": "US",
            "telephone_number": "909-957-4990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAWRENCE",
        "first_name": "BRANDON",
        "middle_name": "KENNETH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-27",
        "last_updated": "2024-04-01",
        "certification_date": "2024-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "14275122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daren B Kunz, PHARM. D.
• Laboratory Corporation of America
• Laboratory Corporation of America
• Donald Lasselle, M.D.
• Mandelise Nafica Laudat, MD
• Ana D Licano, LMP
• Phoebe Dang Lim-Vuong, DNP, FNP-BC
• Fanning Lin
• Jaelyn Lindsey, LICSW
• Alfredo Loera, PA-C

• Family Medicine Physician in Grandview, WA
• Providers in Grandview, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; 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.