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General NPI Number Information
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NPI Number | 1366639452
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Entity Type | Organization
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Legal Business Name | IAN G RENNER, M.D. INC
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 5901 W OLYMPIC BLVD SUITE #300
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City | LOS ANGELES
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State | CA
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Zip | 90036-4667
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Country | US
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Telephone | 310-556-7747
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Fax | 310-556-7757
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Provider Business Mailing Address
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Address Line | 5901 W OLYMPIC BLVD SUITE #300
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City | LOS ANGELES
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State | CA
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Zip | 90036-4667
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Country | US
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Telephone | 310-556-7747
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Fax | 310-556-7757
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Authorized Official
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Title or Position | OWNER
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Name | IAN G RENNER
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Credential | M.D.
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Telephone | 310-556-7747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A34010
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License Number State | CA
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