Provider Demographics
NPI:1629129143
Name:DANESH, GINA (DO)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:DANESH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1158 26TH ST
Mailing Address - Street 2:449
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4621
Mailing Address - Country:US
Mailing Address - Phone:213-742-7777
Mailing Address - Fax:213-742-0808
Practice Address - Street 1:1740 S LOS ANGELES ST
Practice Address - Street 2:105
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3632
Practice Address - Country:US
Practice Address - Phone:213-742-7777
Practice Address - Fax:213-742-0808
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8286208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A8286Medicare ID - Type UnspecifiedMEDICAL LICENSE