Healthcare Provider Details

I. General information

NPI: 1801086285
Provider Name (Legal Business Name): DOHENY EYE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7677 CENTER AVE SUITE 400
HUNTINGTON BEACH CA
92647-3074
US

IV. Provider business mailing address

DEPT 6123
LOS ANGELES CA
90084-0001
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-7152
  • Fax:
Mailing address:
  • Phone: 323-442-7152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RONALD E SMITH
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 323-442-6424