Provider Demographics
NPI:1366639452
Name:IAN G RENNER, M.D. INC
Entity Type:Organization
Organization Name:IAN G RENNER, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:RENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-556-7747
Mailing Address - Street 1:5901 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4667
Mailing Address - Country:US
Mailing Address - Phone:310-556-7747
Mailing Address - Fax:310-556-7757
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:SUITE #300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:310-556-7747
Practice Address - Fax:310-556-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34010207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11894Medicare PIN
CAWA34010BMedicare PIN
CAW17392Medicare UPIN