Healthcare Provider Details

I. General information

NPI: 1841446945
Provider Name (Legal Business Name): KAREN J DAVIS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 E 10TH ST
LONG BEACH CA
90813-4424
US

IV. Provider business mailing address

432 E 10TH ST
LONG BEACH CA
90813-4424
US

V. Phone/Fax

Practice location:
  • Phone: 714-739-5959
  • Fax: 714-739-5974
Mailing address:
  • Phone: 714-739-5959
  • Fax: 714-739-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberA45723
License Number StateCA

VIII. Authorized Official

Name: DR. KAREN J DAVIS
Title or Position: PRESIDENT
Credential: MD
Phone: 714-739-5959