1215919147 NPI number — JEFFREY A DOBKIN MD

Table of content: JEFFREY A DOBKIN MD (NPI 1215919147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215919147 NPI number — JEFFREY A DOBKIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOBKIN
Provider First Name:
JEFFREY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215919147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92659-0109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-434-8663
Provider Business Mailing Address Fax Number:
714-549-9287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2708 E WILLOW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIGNAL HILL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90755-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-427-0714
Provider Business Practice Location Address Fax Number:
603-773-3685
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085N0904X , with the licence number:  G73366 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1295830396 . This is a "TYPE 2" identifier . This identifiers is of the category "OTHER".




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