Provider Demographics
NPI:1164461752
Name:FRIEND, DAVID I (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:I
Last Name:FRIEND
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 1:14916 GREENLEAF ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4003
Mailing Address - Country:US
Mailing Address - Phone:818-212-0540
Mailing Address - Fax:
Practice Address - Street 1:14916 GREENLEAF ST
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-4003
Practice Address - Country:US
Practice Address - Phone:818-212-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68378207P00000X
CODR.0063679208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G683780Medicaid
CAWG68378IMedicare PIN
CAWG68378GMedicare PIN
WG68378CMedicare PIN
CAWG68378HMedicare PIN
CADV586ZMedicare PIN
CA00G683780Medicaid