Provider Demographics
NPI:1154492213
Name:RICHARD A ENNS MD INC
Entity Type:Organization
Organization Name:RICHARD A ENNS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ENNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-891-1731
Mailing Address - Street 1:7677 CENTER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3074
Mailing Address - Country:US
Mailing Address - Phone:714-891-1731
Mailing Address - Fax:714-891-0129
Practice Address - Street 1:7677 CENTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3074
Practice Address - Country:US
Practice Address - Phone:714-891-1731
Practice Address - Fax:714-891-0129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A293270Medicaid
CAA87226Medicare UPIN
CA00A293270Medicaid