Provider Demographics
NPI:1174587562
Name:NOESEN, DENNIS H (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:H
Last Name:NOESEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1572
Mailing Address - Country:US
Mailing Address - Phone:562-595-1961
Mailing Address - Fax:562-595-5351
Practice Address - Street 1:2840 LONG BEACH BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1572
Practice Address - Country:US
Practice Address - Phone:562-595-1961
Practice Address - Fax:562-595-5351
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAN8786242207V00000X
CAG39916363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW385Medicare ID - Type Unspecified
WG39916AMedicare PIN
CAA48013Medicare UPIN
A48013Medicare UPIN