MEDICARE: DAVID A DENENHOLZ MD INC.

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1447295860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID A DENENHOLZ MD INC.

Provider Business Mailing Address
First Line	:	960 E GREEN ST STE 330
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2401
Country	:	US
Telephone Number	:	626-449-4207
Fax Number	:	626-449-0925

Provider Business Practice Location Address
First Line	:	960 E GREEN ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2401
Country	:	US
Telephone Number	:	626-449-4207
Fax Number	:	626-449-0925

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID A DENENHOLZ
Credential	:	MD
Telephone Number	:	626-449-4207

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	09/12/2008

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