Healthcare Provider Details

I. General information

NPI: 1275704579
Provider Name (Legal Business Name): DEAN FERDOWS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 SLAUSON AVE
MAYWOOD CA
90270-2838
US

IV. Provider business mailing address

PO BOX 412
PACIFIC PALISADES CA
90272-0412
US

V. Phone/Fax

Practice location:
  • Phone: 323-773-2020
  • Fax: 323-771-6069
Mailing address:
  • Phone: 323-773-2020
  • Fax: 323-771-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA46360
License Number StateCA

VIII. Authorized Official

Name: DEAN FERDOWS
Title or Position: M.D.
Credential:
Phone: 323-773-2020