Provider Demographics
NPI:1730376211
Name:DENNIS C. JEROME M.D.
Entity type:Organization
Organization Name:DENNIS C. JEROME M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:JEROME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-963-5163
Mailing Address - Street 1:20302 EASTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4719
Mailing Address - Country:US
Mailing Address - Phone:714-963-5163
Mailing Address - Fax:714-963-5163
Practice Address - Street 1:5901 E 7TH ST
Practice Address - Street 2:111A
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822-5201
Practice Address - Country:US
Practice Address - Phone:562-826-5485
Practice Address - Fax:562-826-5485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC 34461207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35627Medicare UPIN