Provider Demographics
NPI:1043396690
Name:STEPHEN C DINSMORE MD INC
Entity Type:Organization
Organization Name:STEPHEN C DINSMORE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STEPHEN C DINSMORE MD
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DINSMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:310-370-3628
Mailing Address - Street 1:19000 HAWTHORNE BLVD
Mailing Address - Street 2:STEPHEN C DINSMORE MD INC #110
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1517
Mailing Address - Country:US
Mailing Address - Phone:310-370-3628
Mailing Address - Fax:310-371-7863
Practice Address - Street 1:19000 HAWTHORNE BLVD
Practice Address - Street 2:STEPHEN C DINSMORE MD INC #110
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1517
Practice Address - Country:US
Practice Address - Phone:310-370-3628
Practice Address - Fax:310-371-7863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWG32005A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAD9568506OtherDEA
A44952Medicare UPIN
CAW455AMedicare ID - Type Unspecified
CAW455Medicare ID - Type Unspecified