Healthcare Provider Details

I. General information

NPI: 1538170808
Provider Name (Legal Business Name): DENNIS WOO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA #265
LOS ANGELES CA
90074
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 200
LOS ANGELES CA
90045-5632
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6923
  • Fax: 310-829-1077
Mailing address:
  • Phone: 310-829-9935
  • Fax: 310-829-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG32682
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG32682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: