Healthcare Provider Details

I. General information

NPI: 1417638768
Provider Name (Legal Business Name): DENNIS STOLPNER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 WILSHIRE BLVD STE 504
LOS ANGELES CA
90048-5223
US

IV. Provider business mailing address

11420 DONA TERESA DR
STUDIO CITY CA
91604-4271
US

V. Phone/Fax

Practice location:
  • Phone: 323-965-9995
  • Fax:
Mailing address:
  • Phone: 323-475-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENNIS STOLPNER
Title or Position: PRESIDENT
Credential:
Phone: 323-475-5077