Provider Demographics
NPI:1215015508
Name:DENNIS, TSHEKEDI G (MD)
Entity Type:Individual
Prefix:DR
First Name:TSHEKEDI
Middle Name:G
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5762 BOLSA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1172
Mailing Address - Country:US
Mailing Address - Phone:714-898-0362
Mailing Address - Fax:714-893-3267
Practice Address - Street 1:5762 BOLSA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1172
Practice Address - Country:US
Practice Address - Phone:714-898-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA963692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA96369OtherSTATE LICENSE
FD0248472OtherDEA
FD4748046OtherDEA
FD8860795OtherDEA
XFD4748046OtherDEA X WAIVER