Healthcare Provider Details

I. General information

NPI: 1043310915
Provider Name (Legal Business Name): GARY DEAN LONDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD SUITE 902
WEST HOLLYWOOD CA
90069-3701
US

IV. Provider business mailing address

10501 WILSHIRE BLVD SUITE 1610
LOS ANGELES CA
90024-6302
US

V. Phone/Fax

Practice location:
  • Phone: 310-270-4500
  • Fax: 310-446-5423
Mailing address:
  • Phone: 310-446-5420
  • Fax: 310-446-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberG7937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: