Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | G21778 | CA |
N | 207PE0004X | Emergency Medical Services | G21778 | CA |
NPI | 1184610164 |
---|---|
Provider Name | Dr. Wendy Denham |
First Address | Los Angeles, CA 90051-0717 |
Second Address | West Hollywood, CA 90048-1804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H04805 | (02) | CA |