Provider Demographics
NPI:1366516478
Name:DOAN, STEVEN P (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:DOAN
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 1:625 S FAIR OAKS AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2665
Mailing Address - Country:US
Mailing Address - Phone:626-229-9865
Mailing Address - Fax:626-229-9867
Practice Address - Street 1:625 S FAIR OAKS AVE STE 245
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2665
Practice Address - Country:US
Practice Address - Phone:626-229-9865
Practice Address - Fax:626-229-9867
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA75950207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366516478Medicaid
CAA75950OtherLICENSE NUMBER
CAH54881Medicare UPIN
CABK271IMedicare PIN
CA1366516478Medicaid