Provider Demographics
NPI:1598903783
Name:DR DORODNY INC
Entity Type:Organization
Organization Name:DR DORODNY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:S
Authorized Official - Last Name:DORODNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, ND, PHD, MPH
Authorized Official - Phone:828-367-6369
Mailing Address - Street 1:30765 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 285
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3646
Mailing Address - Country:US
Mailing Address - Phone:828-367-6369
Mailing Address - Fax:310-457-7383
Practice Address - Street 1:30765 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 285
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3646
Practice Address - Country:US
Practice Address - Phone:828-367-6369
Practice Address - Fax:310-457-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35905207LA0401X, 207R00000X, 208D00000X, 208VP0000X
CAA3509052081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty