Provider Demographics
NPI:1154409761
Name:ARNON, STEFAN DAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:DAN
Last Name:ARNON
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 1:2090 BROADWAY ST APT 804
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1510
Mailing Address - Country:US
Mailing Address - Phone:415-866-4027
Mailing Address - Fax:415-829-3626
Practice Address - Street 1:2090 BROADWAY ST APT 804
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-309-4804
Practice Address - Fax:415-829-3626
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15154208D00000X, 2085R0202X
IL0360417282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G151540Medicaid
CA00G151540Medicaid
00G151540Medicare ID - Type Unspecified