Healthcare Provider Details

I. General information

NPI: 1306043633
Provider Name (Legal Business Name): DAVID EUGENE DASSEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 N FIGUEROA ST ROOM 212
LOS ANGELES CA
90012-2602
US

IV. Provider business mailing address

1918 N HOOVER ST
LOS ANGELES CA
90027-2806
US

V. Phone/Fax

Practice location:
  • Phone: 213-240-7941
  • Fax: 213-482-4856
Mailing address:
  • Phone: 323-660-7238
  • Fax: 213-482-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberC038835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: