Individual
DENNIS THOMAS LANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D,
Contact information
Practice address
101 E BEVERLY BLVD, SUITE 304, MONTEBELLO, CA 90640-4300
(323) 722-7418
Mailing address
14550 DEER PARK CT, LOS GATOS, CA 95032-6620
(408) 358-7766
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
G68910
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G689100
—
CA
01
—
G68910
MEDICAL LICENCE
CA
Enumeration date
10/25/2006
Last updated
07/09/2007
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