Provider Demographics
NPI:1093730061
Name:JESSE, DAVID FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:FRANKLIN
Last Name:JESSE
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 1:3000 E BIRCH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6261
Mailing Address - Country:US
Mailing Address - Phone:714-996-5770
Mailing Address - Fax:714-961-6189
Practice Address - Street 1:3000 E BIRCH ST STE 110
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6261
Practice Address - Country:US
Practice Address - Phone:714-996-5770
Practice Address - Fax:714-961-6189
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39932207P00000X, 207Q00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85353Medicare UPIN
CA008399320Medicare ID - Type Unspecified