Provider Demographics
NPI:1740402486
Name:RUSEN, DAVID SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SAMUEL
Last Name:RUSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:885 OAK GROVE AVE
Mailing Address - Street 2:SUITE # 304
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4433
Mailing Address - Country:US
Mailing Address - Phone:650-949-2424
Mailing Address - Fax:
Practice Address - Street 1:885 OAK GROVE AVE
Practice Address - Street 2:SUITE # 304
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4433
Practice Address - Country:US
Practice Address - Phone:650-949-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA 255252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE 69099Medicare UPIN