Provider Demographics
NPI:1346250016
Name:DAVID CHARLES RISH MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DAVID CHARLES RISH MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:RISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-625-9330
Mailing Address - Street 1:435 N ROXBURY DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5027
Mailing Address - Country:US
Mailing Address - Phone:310-275-5136
Mailing Address - Fax:323-933-5189
Practice Address - Street 1:435 N ROXBURY DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5027
Practice Address - Country:US
Practice Address - Phone:310-625-9330
Practice Address - Fax:323-933-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27861207N00000X, 207ND0101X, 207ND0900X, 207NS0135X
CAG027861207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEE512AMedicare PIN
CAA43524Medicare UPIN
W4360Medicare ID - Type Unspecified