Healthcare Provider Details

I. General information

NPI: 1295830396
Provider Name (Legal Business Name): JEFFREY A. DOBKIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 E WILLOW ST
SIGNAL HILL CA
90755-2217
US

IV. Provider business mailing address

PO BOX 1309
NEWPORT BEACH CA
92659-0109
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-0714
  • Fax: 603-773-3685
Mailing address:
  • Phone: 714-434-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberG73366
License Number StateCA

VIII. Authorized Official

Name: JEFFREY A DOBKIN
Title or Position: OWNER
Credential:
Phone: 714-434-8663