1114904638 NPI number — DAVID S CAMPION MD

Table of content: DAVID S CAMPION MD (NPI 1114904638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114904638 NPI number — DAVID S CAMPION MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPION
Provider First Name:
DAVID
Provider Middle Name:
S
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:
1114904638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10780 SANTA MONICA BLVD
Provider Second Line Business Mailing Address:
#440
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90025-4749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-275-6996
Provider Business Mailing Address Fax Number:
310-275-6997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
436 N BEDFORD DR
Provider Second Line Business Practice Location Address:
#211
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-275-6996
Provider Business Practice Location Address Fax Number:
310-275-6997
Provider Enumeration Date:
12/27/2005

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: 2084N0600X , with the licence number:  A24908 , 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: 00A249081 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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