Provider Demographics
NPI:1164669073
Name:D LEVI HARRISON MD A PROF CORP
Entity Type:Organization
Organization Name:D LEVI HARRISON MD A PROF CORP
Other - Org Name:D LEVI HARRISON MD A PROFESSIONAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D./CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:LEVI
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-240-8001
Mailing Address - Street 1:800 S CENTRAL AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4379
Mailing Address - Country:US
Mailing Address - Phone:818-240-8001
Mailing Address - Fax:818-240-8019
Practice Address - Street 1:800 S CENTRAL AVE STE 204
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4379
Practice Address - Country:US
Practice Address - Phone:818-240-8001
Practice Address - Fax:818-240-8019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73863207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty