Provider Demographics
NPI:1205947611
Name:WENDT, DANIEL E (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:WENDT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3555 KENYON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5341
Mailing Address - Country:US
Mailing Address - Phone:619-221-9547
Mailing Address - Fax:619-224-7269
Practice Address - Street 1:3555 KENYON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5341
Practice Address - Country:US
Practice Address - Phone:619-221-9547
Practice Address - Fax:619-224-7269
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3302213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E33020Medicaid
CA000E33020Medicaid
CAT93450Medicare UPIN