Healthcare Provider Details

I. General information

NPI: 1902860109
Provider Name (Legal Business Name): MARK ANDREW HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S FAIR OAKS AVE
PASADENA CA
91105-2603
US

IV. Provider business mailing address

797 S FAIR OAKS AVE
PASADENA CA
91105-2617
US

V. Phone/Fax

Practice location:
  • Phone: 626-755-3642
  • Fax:
Mailing address:
  • Phone: 626-755-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA87000
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA87000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: