Provider Demographics
NPI:1497779508
Name:ENCE, THOMAS JENKINS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JENKINS
Last Name:ENCE
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 1:18399 VENTURA BLVD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4233
Mailing Address - Country:US
Mailing Address - Phone:818-609-7536
Mailing Address - Fax:818-344-9670
Practice Address - Street 1:18399 VENTURA BLVD
Practice Address - Street 2:SUITE 245
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4233
Practice Address - Country:US
Practice Address - Phone:818-609-7536
Practice Address - Fax:818-344-9670
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30027174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0001370Medicaid
CAA44263Medicare UPIN
CAW120Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER