Healthcare Provider Details

I. General information

NPI: 1982876041
Provider Name (Legal Business Name): STEVEN MARC DAINES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 NEWPORT CENTER DR SUITE 158
NEWPORT BEACH CA
92660-6972
US

IV. Provider business mailing address

PO BOX 15847
NEWPORT BEACH CA
92659-5847
US

V. Phone/Fax

Practice location:
  • Phone: 949-209-1622
  • Fax: 949-209-1623
Mailing address:
  • Phone: 949-209-1622
  • Fax: 949-209-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA120244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: