Healthcare Provider Details

I. General information

NPI: 1366881294
Provider Name (Legal Business Name): WILLIAM MUNDAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 S SEPULVEDA BLVD
LOS ANGELES CA
90064-1784
US

IV. Provider business mailing address

2440 S SEPULVEDA BLVD
LOS ANGELES CA
90064-1784
US

V. Phone/Fax

Practice location:
  • Phone: 310-689-0615
  • Fax:
Mailing address:
  • Phone: 310-689-0615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA144752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: