Individual
BRIAN IM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
6417 HAVEN AVE STE 110, RANCHO CUCAMONGA, CA 91737-3804
(909) 941-2273
(909) 477-8830
Mailing address
6417 HAVEN AVE STE 110, RANCHO CUCAMONGA, CA 91737-3804
(909) 941-2273
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA21262
CA
Other
Enumeration date
10/27/2010
Last updated
03/06/2026
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