MEDICARE: DR. STEPHEN EARL GENENDER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	G20412	CA

General Provider Information

NPI Number	:	1134502784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN EARL GENENDER M.D.

Provider Business Mailing Address
First Line	:	3293 WRIGHTWOOD DR.
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604
Country	:	US
Telephone Number	:	323-654-2226
Fax Number	:	323-654-9895

Provider Business Practice Location Address
First Line	:	3293 WRIGHTWOOD DR.
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604
Country	:	US
Telephone Number	:	323-654-2226
Fax Number	:	323-654-9895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/01/2015

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