DR. DERALD E BRACKMANN (NPI# 1508876699) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508876699 |
| Entity Type | Individual |
| Full Name | DR. DERALD E BRACKMANN |
| Credential | MD |
| Practice Address |
2100 W 3rd St Ste 111 Los Angeles CA 90057-1999 |
| Practice Telephone | 2134839930 |
| Practice Fax Number | 2134830905 |
| Mailing Telephone | 2134839930 |
| Mailing Fax Number | 2134830905 |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2013-09-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0901X |
Otolaryngology Specialization: Otology & Neurotology |
G11124 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G111240 | 05 |
| Street Address |
2100 W 3RD ST STE 111 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90057-1999 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396239745 | Soo Ji Jang | Audiologist | 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999 | 2018-06-19 |
| 1659892149 | Diana Ahn | Audiologist | 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999 | 2017-07-05 |
| 1427397843 | Caithlin E. Macneil | Audiologist | 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999 | 2013-02-05 |
| 1245556653 | Kevin Albert Peng | Otolaryngology | 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999 | 2010-04-09 |
| 1124292719 | Jane M. Gay | Audiologist | 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1922 | 2008-04-15 |
| 1942414479 | Dawna Maria Mills | Audiologist | 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1922 | 2007-05-10 |
| 1013122555 | Cheryl Jeanne Ruhlen | Audiologist | 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1922 | 2007-05-10 |
| 1649485178 | Allen John Senne | Audiologist | 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1922 | 2007-05-10 |
| 1306962550 | Wadad J Shalhub | Audiologist-Hearing Aid Fitter | 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999 | 2007-03-21 |
| 1821121427 | House Clinic | Audiologist | 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1922 | 2007-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013518315 | Mayulee Wilawanwelsh | Massage Therapist | 349 S Lafayette Pk Pl, Los Angeles, CA 90057 | 2020-11-03 |
| 1437714615 | Jackeline L Ramon | Social Worker | 572 S. La Fayette Park Place #6, Los Angeles, CA 90057 | 2019-05-03 |
| 1467015743 | Chanhwi Jung | Acupuncturist | 349 South Lafayette Park Place, #208, Los Angeles, CA 90057 | 2019-04-22 |
| 1356818850 | Anshim Acupuncture Inc | Acupuncturist | 4501 Alameda St., #107b #115, Los Angeles, CA 90057 | 2018-11-01 |
| 1538634670 | Karina Herrera | Case Manager/Care Coordinator | 679 S. Hampshire Ave, Los Angeles, CA 90057 | 2018-10-04 |
| 1306323506 | Jessica Myung Jin Yun | Counselor | 520 S Lafayette Park Pl, Unit 300, Los Angeles, CA 90057 | 2018-07-20 |
| 1851887012 | Scott Moon | Dentist | 2426 W. 8th St. #209, Los Angeles, CA 90057 | 2018-07-10 |
| 1780176107 | Bianca Zafiro | Case Manager/Care Coordinator | 672 S Lafayette Park Place, Suite 6, Los Angeles, CA 90057 | 2018-06-01 |
| 1639677438 | Claudia E Vides Inc A Dental Corporation | Clinic/Center | 2033 W. 7th Street, Los Angeles, CA 90057 | 2018-01-26 |
| 1720596414 | Hee Sun No | Pharmacist | 269 S Lafayette Park Pl, 210, Los Angeles, CA 90057 | 2018-01-16 |
| Find all providers in zip 90057 | ||||
| Taxonomy Code | 207YX0901X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Otology & Neurotology |
| An otolaryngologist who treats diseases of the ear and temporal bone, including disorders of hearing and balance. The additional training in otology and neurotology emphasizes the study of embryology, anatomy, physiology, epidemiology, pathophysiology, pathology, genetics, immunology, microbiology and the etiology of diseases of the ear and temporal bone. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629075635 | John Steven Oghalai | Otolaryngology | 1450 San Pablo St Ste 5100, Los Angeles, CA 90033-4500 | 2005-07-05 |
| 1245556653 | Kevin Albert Peng | Otolaryngology | 2100 W 3rd St Ste 111, Los Angeles, CA 90057-1999 | 2010-04-09 |
| 1790017960 | Nopawan Vorasubin | Otolaryngology | 4867 W Sunset Blvd, Los Angeles, CA 90027-5969 | 2010-02-12 |
| 1598998502 | South Coast Diagnostic Medical Group | Otolaryngology | 7095 Hollywood Blvd, 742, Los Angeles, CA 90028-8903 | 2009-08-25 |
| 1730315425 | Brian Shinrong Chen | Otolaryngology | 2100 W 3rd St, Suite 111, Los Angeles, CA 90057-1944 | 2009-06-08 |
| 1033399498 | Universal Diagnostic Medical Group, Inc. | Otolaryngology | 4322 Wilshire Blvd, Ste 303, Los Angeles, CA 90010-3793 | 2007-11-13 |
| 1417051095 | John W House | Otolaryngology | 2100 W 3rd St, Suite 111, Los Angeles, CA 90057-1944 | 2006-09-12 |
| 1982708558 | Rick A Friedman | Otolaryngology | 1520 San Pablo St, 4th Floor, Los Angeles, CA 90033-5310 | 2006-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962845834 | Yuan Liu | Otolaryngology | 11234 Anderson St Rm 2586a, Loma Linda, CA 92354-2804 | 2013-04-10 |
| 1699017301 | Shohet Ear Associates Medical Group Inc | Otolaryngology | 770 Pacific Coast Hwy, Seal Beach, CA 90740-6379 | 2013-03-20 |
| 1801152665 | Center for Fall Prevention, A Medical Corporation | Otolaryngology | 3831 Hughes Ave Ste 608, Culver City, CA 90232-6851 | 2012-04-05 |
| 1700151909 | Stuart Gerard Gherini | Otolaryngology | 1056 38th St, Sacramento, CA 95816-5513 | 2012-03-20 |
| 1144420738 | Shohet Ear Associates Medical Group Inc | Otolaryngology | 446 Old Newport Beach Blvd, Shohet Ear Associates Medical Group Inc, Newport Beach, CA 92663-4246 | 2007-07-20 |
| 1952426017 | Hernan Goldsztein | Otolaryngology | 530 Lomas Santa Fe Dr Ste 1, Solana Beach, CA 92075-1350 | 2007-03-20 |
| 1932253960 | Hana T. Bui, Md, A Professional Corporation | Otolaryngology | 1321 N Harbor Blvd Ste 101, Fullerton, CA 92835-4129 | 2007-01-23 |
| 1356344022 | Kevin X Mckennan | Otolaryngology | 1111 Exposition Blvd Bldg 700, Sacramento, CA 95815-4314 | 2005-05-24 |
| 1144873613 | Doron Sagiv | Otolaryngology | 2521 Stockton Blvd Ste 7200, Sacramento, CA 95817-2207 | 2019-07-23 |
| 1699288027 | Haley Morgan Roberson | Otolaryngology | 1900 University Ave Ste 101, East Palo Alto, CA 94303-2213 | 2017-11-07 |
| Find all providers with the same taxonomy | ||||
| City | LOS ANGELES |
| Zip Code | 90057 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.