Provider Demographics
NPI:1295866341
Name:MCDONOUGH, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4015 N WALNUTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3927
Mailing Address - Country:US
Mailing Address - Phone:310-288-5933
Mailing Address - Fax:866-683-4556
Practice Address - Street 1:12721 NEWPORT AVE STE 3
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-8031
Practice Address - Country:US
Practice Address - Phone:310-288-5933
Practice Address - Fax:866-683-4556
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG73043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG73043NOtherMEDICARE ID-UNSPEC
CA3045033Medicaid
CAWG73043NOtherMEDICARE ID-UNSPEC