Provider Demographics
NPI:1043268394
Name:DIBDIN, JAMES DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DONALD
Last Name:DIBDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 WILSHIRE BLVD #234
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-593-3945
Mailing Address - Fax:
Practice Address - Street 1:505 COAST BLVD SOUTH # 408
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4613
Practice Address - Country:US
Practice Address - Phone:858-459-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-12-21
Deactivation Date:2022-05-23
Deactivation Code:
Reactivation Date:2022-08-26
Provider Licenses
StateLicense IDTaxonomies
CAA39483207Q00000X, 207ZP0101X, 207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAY406CMedicare PIN
CAE02520Medicare UPIN