Healthcare Provider Details

I. General information

NPI: 1144343146
Provider Name (Legal Business Name): JOSHUA MICHAEL IAN DAVIDSON M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSHUA M DAVIDSON MD

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 TORRANCE BLVD
REDONDO BEACH CA
90277-3413
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 310-792-8393
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA88990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: