Provider Demographics
NPI:1407869977
Name:LEVI, DANIEL STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:STEVEN
Last Name:LEVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:12-441 MDCC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-825-5296
Mailing Address - Fax:310-825-9524
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:12-441 MDCC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-825-5296
Practice Address - Fax:310-825-9524
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA671982080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A671980Medicaid
CAGR0053510Medicaid
CAWA67198AMedicare ID - Type Unspecified
CAH97829Medicare UPIN
CAW11810Medicare ID - Type UnspecifiedGROUP NUMBER