Healthcare Provider Details

I. General information

NPI: 1043278062
Provider Name (Legal Business Name): JEFFREY W. BIRNS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18425 BURBANK BLVD SUITE 412
TARZANA CA
91356-2806
US

IV. Provider business mailing address

18425 BURBANK BLVD SUITE 412
TARZANA CA
91356-2806
US

V. Phone/Fax

Practice location:
  • Phone: 818-905-8118
  • Fax:
Mailing address:
  • Phone: 818-905-8118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberG031963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: