Provider Demographics
NPI:1699165738
Name:DEEN MEDICAL GROUP INC
Entity type:Organization
Organization Name:DEEN MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMER
Authorized Official - Middle Name:JAVED
Authorized Official - Last Name:DEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-343-9639
Mailing Address - Street 1:46 PENINSULA CTR STE E
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3562
Mailing Address - Country:US
Mailing Address - Phone:775-343-9639
Mailing Address - Fax:
Practice Address - Street 1:46 PENINSULA CTR STE E
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3562
Practice Address - Country:US
Practice Address - Phone:775-343-9639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty