Provider Demographics
NPI:1962508242
Name:ENTIN, ALLEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:M
Last Name:ENTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18370 BURBANK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2804
Mailing Address - Country:US
Mailing Address - Phone:818-708-1090
Mailing Address - Fax:818-708-3238
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-708-1090
Practice Address - Fax:818-708-3238
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG32015207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91387Medicare UPIN
CAWG32015AMedicare ID - Type UnspecifiedPHYSICIAN