Healthcare Provider Details

I. General information

NPI: 1831590439
Provider Name (Legal Business Name): ILAN JACOB DANAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 PARK TER
LOS ANGELES CA
90045-1543
US

IV. Provider business mailing address

6801 PARK TER
LOS ANGELES CA
90045-1543
US

V. Phone/Fax

Practice location:
  • Phone: 310-665-7229
  • Fax:
Mailing address:
  • Phone: 310-665-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License NumberA133500
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberA133500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: