Provider Demographics
NPI:1427077684
Name:OPAI-TETTEH, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:OPAI-TETTEH
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 1:4335 VAN NUYS BLVD
Mailing Address - Street 2:SUTIE 315
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3727
Mailing Address - Country:US
Mailing Address - Phone:909-649-8031
Mailing Address - Fax:909-989-6895
Practice Address - Street 1:8200 HAVEN AVENUE
Practice Address - Street 2:STE101
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-649-8031
Practice Address - Fax:909-989-6895
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53194207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A531940Medicaid
CA00A531940Medicaid
G88950Medicare UPIN