MEDICARE: DANIEL B ALLEN 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	2086S0122X	Plastic and Reconstructive Surgery Physician	G71411	CA

General Provider Information

NPI Number	:	1790896538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL B ALLEN MD INC

Provider Business Mailing Address
First Line	:	13847 EAST 14TH STREET
Second Line	:	SUITE 109
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2625
Country	:	US
Telephone Number	:	510-357-7141
Fax Number	:	510-357-4274

Provider Business Practice Location Address
First Line	:	13847 EAST 14TH STREET
Second Line	:	SUITE 109
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2625
Country	:	US
Telephone Number	:	510-357-7141
Fax Number	:	510-357-4274

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL B ALLEN
Credential	:	MD
Telephone Number	:	510-357-7141

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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