Provider Demographics
NPI:1447203567
Name:MALKASIAN, DENNIS R (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
Last Name:MALKASIAN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
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Mailing Address - Street 1:400 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7601
Mailing Address - Country:US
Mailing Address - Phone:949-720-1390
Mailing Address - Fax:949-720-8027
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 310
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-720-1390
Practice Address - Fax:949-720-8027
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA26001207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000A26001Medicaid
CA000A26001Medicaid
CAA26001Medicare PIN