Provider Demographics
NPI:1902931157
Name:EISENMAN, DANA GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:GREGORY
Last Name:EISENMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1125 S BEVERLY DR STE 700
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1180
Mailing Address - Country:US
Mailing Address - Phone:310-360-7671
Mailing Address - Fax:310-360-6754
Practice Address - Street 1:1125 S BEVERLY DR STE 700
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1180
Practice Address - Country:US
Practice Address - Phone:310-360-7671
Practice Address - Fax:310-360-6754
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2024-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA63578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH27992Medicare UPIN