Provider Demographics
NPI:1760824692
Name:LANDRY, DAVID (MD, BENG)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:LANDRY
Suffix:
Gender:M
Credentials:MD, BENG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 3RD ST
Mailing Address - Street 2:APT. 1001
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2303
Mailing Address - Country:US
Mailing Address - Phone:415-926-1059
Mailing Address - Fax:
Practice Address - Street 1:1560 3RD ST
Practice Address - Street 2:APT. 1001
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2303
Practice Address - Country:US
Practice Address - Phone:415-926-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126563282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital