Provider Demographics
NPI:1609801760
Name:LANDAU, JOSEPH W (M D)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:LANDAU
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2045
Mailing Address - Country:US
Mailing Address - Phone:310-828-4494
Mailing Address - Fax:310-828-3254
Practice Address - Street 1:2428 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2045
Practice Address - Country:US
Practice Address - Phone:310-828-4494
Practice Address - Fax:310-828-3254
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG4281207N00000X, 207NP0225X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G42810OtherBLUE SHIELD
CA952963650OtherBLUE CROSS
952963650OtherFEDERAL TAX
CA000G42810Medicaid
05D0549998OtherCLIA
CAA56440Medicare UPIN
CA000G42810Medicaid