Provider Demographics
NPI:1245284645
Name:FRENKIEL, PAUL G (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:FRENKIEL
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:DEPT LA 23039
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-3039
Mailing Address - Country:US
Mailing Address - Phone:562-282-4038
Mailing Address - Fax:562-658-3397
Practice Address - Street 1:9040 TELEGRAPH RD STE 100
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-2395
Practice Address - Country:US
Practice Address - Phone:562-861-0954
Practice Address - Fax:562-923-0966
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33450207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G334500OtherBLUE SHIELD ID #
005344OtherHEALTH NET ID #
110219119OtherRAILROAD
12019120OtherRAILROAD
CA00G334500Medicaid
110219119OtherRAILROAD
CAWG33450FMedicare PIN
CAWG33450JMedicare PIN
00G334500OtherBLUE SHIELD ID #
CA00G334500Medicaid
CAWG33450HMedicare PIN