Provider Demographics
NPI:1811028129
Name:DAVID R. JOSS,MD A CALIFORNIA PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID R. JOSS,MD A CALIFORNIA PROFESSIONAL CORPORATION
Other - Org Name:JOSS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-777-1773
Mailing Address - Street 1:21580 YORBA LINDA BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3748
Mailing Address - Country:US
Mailing Address - Phone:714-777-1773
Mailing Address - Fax:714-777-0387
Practice Address - Street 1:21580 YORBA LINDA BLVD
Practice Address - Street 2:STE 102
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-3748
Practice Address - Country:US
Practice Address - Phone:714-777-1773
Practice Address - Fax:714-777-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49533174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15387Medicare ID - Type UnspecifiedGRP MEDICARE ID