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General NPI Number Information
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NPI Number | 1780620138
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Entity Type | Individual
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Provider Name | JEAN WILLIAM BARDENHEIER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 914 E GLADSTONE ST
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City | AZUSA
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State | CA
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Zip | 91702-4747
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Country | US
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Telephone | 626-966-4506
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 702-579-3203
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G26965
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License Number State | CA
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