Basic Information
| Provider Information | |||||||||
| NPI: | 1326203936 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEHN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2516 STOCKTON BLVD # 254 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167345076 | ||||||||
| FaxNumber: | 9164522112 | ||||||||
| Practice Location | |||||||||
| Address1: | 4860 Y ST STE 1600 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167343630 | ||||||||
| FaxNumber: | 9167345550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2008 | ||||||||
| LastUpdateDate: | 07/23/2008 | ||||||||
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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 | 363A00000X | 10432 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 000902 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.