Provider Demographics
NPI:1447273263
Name:DAN LA MD INC
Entity type:Organization
Organization Name:DAN LA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-265-2250
Mailing Address - Street 1:801 S CHEVY CHASE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4431
Mailing Address - Country:US
Mailing Address - Phone:818-265-2250
Mailing Address - Fax:818-265-2268
Practice Address - Street 1:801 S CHEVY CHASE DR
Practice Address - Street 2:STE 101
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4431
Practice Address - Country:US
Practice Address - Phone:818-265-2250
Practice Address - Fax:818-265-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84795207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A847950Medicaid
CAA84795OtherCA MEDICAL LICENSE NUMBER
CA00A847950Medicaid