Healthcare Provider Details

I. General information

NPI: 1942379755
Provider Name (Legal Business Name): DAVID W MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 ETIWANDA AVE STE 211
TARZANA CA
91356-6136
US

IV. Provider business mailing address

5525 ETIWANDA AVE STE 211
TARZANA CA
91356-6136
US

V. Phone/Fax

Practice location:
  • Phone: 818-609-0600
  • Fax: 818-609-1680
Mailing address:
  • Phone: 818-609-0600
  • Fax: 818-609-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number135733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: