Provider Demographics
NPI:1538115290
Name:DO, HENRY D (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:D
Last Name:DO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12900 PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-741-4421
Mailing Address - Fax:562-741-4479
Practice Address - Street 1:11525 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4985
Practice Address - Country:US
Practice Address - Phone:562-862-3684
Practice Address - Fax:562-862-7145
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA77453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A774530OtherBLUE SHIELD ID #
106710OtherHEALTH NET ID #
CA00A774530Medicaid
CAWA77453AMedicare PIN
106710OtherHEALTH NET ID #
00A774530OtherBLUE SHIELD ID #