Provider Demographics
NPI:1518022524
Name:GUTKIN, DAVID JON (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JON
Last Name:GUTKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3377
Mailing Address - Country:US
Mailing Address - Phone:310-560-3656
Mailing Address - Fax:
Practice Address - Street 1:3405 OCEAN DR
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3377
Practice Address - Country:US
Practice Address - Phone:310-560-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9571207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine