Provider Demographics
NPI:1891866950
Name:ENNS, RICHARD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:ENNS
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 1:7677 CENTER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3074
Mailing Address - Country:US
Mailing Address - Phone:714-891-1731
Mailing Address - Fax:714-891-0129
Practice Address - Street 1:7677 CENTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3074
Practice Address - Country:US
Practice Address - Phone:714-891-1731
Practice Address - Fax:714-891-0129
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A293270Medicaid
CAA29327Medicare ID - Type Unspecified
CAA87226Medicare UPIN