Provider Demographics
NPI:1174674980
Name:DENQ CORPORATION
Entity Type:Organization
Organization Name:DENQ CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DENQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-885-1005
Mailing Address - Street 1:18251 ROSCOE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4200
Mailing Address - Country:US
Mailing Address - Phone:818-885-1005
Mailing Address - Fax:818-885-7811
Practice Address - Street 1:18251 ROSCOE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4200
Practice Address - Country:US
Practice Address - Phone:818-885-1005
Practice Address - Fax:818-885-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA065839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A658390Medicaid
CAA65839Medicare ID - Type Unspecified