Active NPI
Brandon Lum
- Physical Therapist
- Garden Grove, CA
National Provider Identifier
1467238477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 303202
- Practice address
- 13075 Blackbird St
Garden Grove, CA 92843-2902 - Phone
- (714) 530-6322
- NPI assigned
- Sep 5, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 303202 | CA | Primary |
Addresses
Primary practice location
13075 Blackbird St
Garden Grove, CA 92843-2902
Mailing address
15 Wintergreen
Irvine, CA 92604-2800
Phone (808) 352-7783
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 303202 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693872000000",
"number": "1467238477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 WINTERGREEN",
"city": "IRVINE",
"state": "CA",
"postal_code": "926042800",
"telephone_number": "808-352-7783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13075 BLACKBIRD ST",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928432902",
"telephone_number": "714-530-6322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUM",
"first_name": "BRANDON",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-09-05",
"last_updated": "2023-09-05",
"certification_date": "2023-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "303202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.