Provider Demographics
NPI:1639221948
Name:BURNHAM JR., WALTER HYNAN (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:HYNAN
Last Name:BURNHAM JR.
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 1:10 CONGRESS ST
Mailing Address - Street 2:SUITE103
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3045
Mailing Address - Country:US
Mailing Address - Phone:626-795-0282
Mailing Address - Fax:626-792-0682
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:SUITE103
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3045
Practice Address - Country:US
Practice Address - Phone:626-795-0282
Practice Address - Fax:626-792-0682
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62133207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine