MEDICARE: DENNIS RONALD NOVAK MD

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	207RP1001X	Pulmonary Disease Physician	G29857	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G29857	OTHER		LICENSE

General Provider Information

NPI Number	:	1336158211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS RONALD NOVAK MD

Provider Business Mailing Address
First Line	:	320 SUPERIOR AVE
Second Line	:	SUITE 200
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-2741
Country	:	US
Telephone Number	:	949-642-6200
Fax Number	:	949-642-9359

Provider Business Practice Location Address
First Line	:	320 SUPERIOR AVE
Second Line	:	SUITE 200
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-2741
Country	:	US
Telephone Number	:	949-642-6200
Fax Number	:	949-642-9359

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	03/07/2023

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