Provider Demographics
NPI:1508271263
Name:DAVID DORFMAN MD INC
Entity Type:Organization
Organization Name:DAVID DORFMAN MD INC
Other - Org Name:DORFMAN PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:DORFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-601-3457
Mailing Address - Street 1:6226 E SPRING ST STE 380
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1444
Mailing Address - Country:US
Mailing Address - Phone:562-595-6543
Mailing Address - Fax:562-595-1414
Practice Address - Street 1:6226 E SPRING ST STE 380
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1444
Practice Address - Country:US
Practice Address - Phone:562-595-6543
Practice Address - Fax:562-595-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1063402086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty