Provider Demographics
NPI:1942435433
Name:BIRKHAUSER, JENNIFER LEE ALTMAN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE ALTMAN
Last Name:BIRKHAUSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:ALTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:510 SUPERIOR AVE
Mailing Address - Street 2:STE 200B
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3663
Mailing Address - Country:US
Mailing Address - Phone:949-791-3001
Mailing Address - Fax:
Practice Address - Street 1:4870 BARRANCA PKWY
Practice Address - Street 2:STE 300
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4709
Practice Address - Country:US
Practice Address - Phone:949-791-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109336208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEY992WMedicare PIN