Provider Demographics
NPI:1841244902
Name:DANIEL B. LENSINK MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DANIEL B. LENSINK MD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LENSINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-229-7700
Mailing Address - Street 1:2510 AIRPARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2449
Mailing Address - Country:US
Mailing Address - Phone:530-229-7700
Mailing Address - Fax:530-229-3945
Practice Address - Street 1:2510 AIRPARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2449
Practice Address - Country:US
Practice Address - Phone:530-229-7700
Practice Address - Fax:530-229-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59926261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE19807Medicare UPIN