Jack Mark Dender, M.D., PSY.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A34535 Issued in CA

Practice address

16055 Ventura Blvd
Suite 919
Encino, CA 91436-2601

Phone

(818) 606-8376

Fax

(818) 783-4403

NPI assigned

Mar 6, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450051200000",
    "number": "1548534787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1631 ALTA VISTA PL",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930124011",
            "telephone_number": "818-606-8376",
            "fax_number": "805-482-8326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16055 VENTURA BLVD",
            "address_2": "SUITE 919",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362601",
            "telephone_number": "818-606-8376",
            "fax_number": "818-783-4403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENDER",
        "first_name": "JACK",
        "middle_name": "MARK",
        "credential": "M.D., PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-06",
        "last_updated": "2015-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A34535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD OF QUALITY ASSURANCE",
            "identifier": "A034535",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Encino, CA
• Providers in Encino, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.