Provider Demographics
NPI:1659305027
Name:HOM, DAVID BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRIAN
Last Name:HOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:800-926-8273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50542207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1009140OtherPREFERRED ONE
MN768158OtherARAZ
MN100883OtherUCARE
MN10-22588OtherMEDICA CHOICE
MN10-00019OtherMEDICA PRIMARY
MNHP19879OtherHEALTHPARTNERS
MN357595100Medicaid
MN2T113HOOtherBCBS
MN040008704Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE
OHHO4200082Medicare PIN
MN100883OtherUCARE
OHHO4200084Medicare PIN
MNHP19879OtherHEALTHPARTNERS
MN357595100Medicaid
OHHO4200083Medicare PIN