Provider Demographics
NPI:1437178274
Name:LA, DAN T (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:T
Last Name:LA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:6673 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2706
Mailing Address - Country:US
Mailing Address - Phone:818-265-2250
Mailing Address - Fax:818-265-2268
Practice Address - Street 1:6673 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2706
Practice Address - Country:US
Practice Address - Phone:818-265-2250
Practice Address - Fax:818-265-2268
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84795207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20219OtherGROUP ID
CAI27571Medicare UPIN
CAWA84793CMedicare PIN