Healthcare Provider Details

I. General information

NPI: 1477592806
Provider Name (Legal Business Name): JEFFREY HUNTER DENHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CONGRESS ST SUITE 201B
PASADENA CA
91105-3024
US

IV. Provider business mailing address

39 CONGRESS ST SUITE 201B
PASADENA CA
91105-3024
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-6113
  • Fax: 626-293-1055
Mailing address:
  • Phone: 626-256-6010
  • Fax: 855-877-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA67746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: