Provider Demographics
NPI:1295830396
Name:JEFFREY A. DOBKIN, INC.
Entity Type:Organization
Organization Name:JEFFREY A. DOBKIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOBKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-434-8663
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0109
Mailing Address - Country:US
Mailing Address - Phone:714-434-8663
Mailing Address - Fax:
Practice Address - Street 1:2708 E WILLOW ST
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2217
Practice Address - Country:US
Practice Address - Phone:562-427-0714
Practice Address - Fax:603-773-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG733662085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215919147OtherTYPE 1
CAE65372Medicare UPIN
CAW19988Medicare PIN