Provider Demographics
NPI:1427246701
Name:DANIEL K. DEA M.D., INC.
Entity type:Organization
Organization Name:DANIEL K. DEA M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:KWAN
Authorized Official - Last Name:DEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-846-2766
Mailing Address - Street 1:2701 W ALAMEDA AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4411
Mailing Address - Country:US
Mailing Address - Phone:818-846-2766
Mailing Address - Fax:
Practice Address - Street 1:2701 W ALAMEDA AVE STE 601
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4411
Practice Address - Country:US
Practice Address - Phone:818-846-2766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF63987Medicare UPIN
CAW21261Medicare PIN