Basic Information
| Provider Information | |||||||||
| NPI: | 1316443435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRODKE | ||||||||
| FirstName: | DANE | ||||||||
| MiddleName: | JENSEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | ORTHOPAEDIC SURGERY - ROOM 76-143 CHS | ||||||||
| Address2: | 10833 LE CONTE AVENUE | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108256557 | ||||||||
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| Practice Location | |||||||||
| Address1: | 757 WESTWOOD PLAZA, (ORTHOPAEDIC SURGERY) | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108256557 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2018 | ||||||||
| LastUpdateDate: | 08/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 163519 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.