Provider Demographics
NPI:1043873029
Name:DAVID, KATHY (REEG/EPT, CNIM)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:REEG/EPT, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 1/2 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5019
Mailing Address - Country:US
Mailing Address - Phone:562-234-8517
Mailing Address - Fax:
Practice Address - Street 1:20331 IRVINE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0223
Practice Address - Country:US
Practice Address - Phone:877-987-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist