Provider Demographics
NPI:1720004690
Name:GUTFINGER, DAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:E
Last Name:GUTFINGER
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 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:949-751-9577
Mailing Address - Fax:949-679-9615
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 502
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:949-751-9577
Practice Address - Fax:949-679-9615
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29144208G00000X
CAA83536208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A835360OtherMEDICAL
CAWA83536AMedicare ID - Type UnspecifiedPRIVATE PRACTICE
CAH88855Medicare UPIN
CAWA83536BMedicare ID - Type Unspecified
CAH88555Medicare UPIN