Healthcare Provider Details

I. General information

NPI: 1003673815
Provider Name (Legal Business Name): DEAN PRINCE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14501 CALVERT ST STE 200
VAN NUYS CA
91411-2806
US

IV. Provider business mailing address

14501 CALVERT ST STE 200
VAN NUYS CA
91411-2806
US

V. Phone/Fax

Practice location:
  • Phone: 310-987-7873
  • Fax:
Mailing address:
  • Phone: 310-987-7873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEAN PRINCE
Title or Position: PRESIDENT
Credential: MD
Phone: 310-987-7873