Provider Demographics
NPI:1407994817
Name:DEN MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:DEN MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DENENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-941-3112
Mailing Address - Street 1:746 ALTOS OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5401
Mailing Address - Country:US
Mailing Address - Phone:650-941-3112
Mailing Address - Fax:650-941-4392
Practice Address - Street 1:746 ALTOS OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5401
Practice Address - Country:US
Practice Address - Phone:650-941-3112
Practice Address - Fax:650-941-4392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C04048Medicare UPIN
CA0872750001Medicare NSC
CA00C261470Medicare PIN