Healthcare Provider Details

I. General information

NPI: 1083742241
Provider Name (Legal Business Name): DENNIS R. GUMM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508A ATLANTIC AVE # A138
LONG BEACH CA
90807-1513
US

IV. Provider business mailing address

3505 LONG BEACH BLVD SUITE 2F
LONG BEACH CA
90807-3907
US

V. Phone/Fax

Practice location:
  • Phone: 310-378-5424
  • Fax:
Mailing address:
  • Phone: 310-378-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: