Healthcare Provider Details

I. General information

NPI: 1508271263
Provider Name (Legal Business Name): DAVID DORFMAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 E SPRING ST STE 380
LONG BEACH CA
90815-1444
US

IV. Provider business mailing address

6226 E SPRING ST STE 380
LONG BEACH CA
90815-1444
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-6543
  • Fax: 562-595-1414
Mailing address:
  • Phone: 562-595-6543
  • Fax: 562-595-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA106340
License Number StateCA

VIII. Authorized Official

Name: DAVID WADE DORFMAN
Title or Position: OWNER
Credential:
Phone: 916-601-3457