Basic Information
Provider Information
NPI: 1376601245
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WORDEN
FirstName: BRIAN
MiddleName: FRANCIS
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5601 DE SOTO AVE
Address2:  
City: WOODLAND HILLS
State: CA
PostalCode: 913676701
CountryCode: US
TelephoneNumber: 8187193700
FaxNumber:  
Practice Location
Address1: 801 WELCH RD
Address2:  
City: PALO ALTO
State: CA
PostalCode: 943041611
CountryCode: US
TelephoneNumber: 6507256500
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/04/2006
LastUpdateDate: 10/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000XA92320CAY Allopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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