Healthcare Provider Details

I. General information

NPI: 1023042496
Provider Name (Legal Business Name): DUDLEY S DANOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST SUITE 1 WEST
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST SUITE 1 WEST
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-854-9898
  • Fax: 310-854-0267
Mailing address:
  • Phone: 310-854-9898
  • Fax: 310-854-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG10704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: