Individual
DENNIS M GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1950 SAWTELLE BLVD, LOS ANGELES, CA 90025-7014
(310) 996-9355
(310) 312-4913
Mailing address
23388 MULHOLLAND DR, MAILSTOP 62, WOODLAND HILLS, CA 91364-2733
(310) 996-9355
(310) 312-4913
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G55353
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G553530
BLUE SHIELD
CA
Enumeration date
09/26/2006
Last updated
06/24/2009
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