Provider Demographics
NPI:1851376511
Name:FUERST, DAVID JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JONATHAN
Last Name:FUERST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1135 S. SUNSET AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:626-856-2020
Mailing Address - Fax:626-962-0974
Practice Address - Street 1:1135 S. SUNSET AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3965
Practice Address - Country:US
Practice Address - Phone:626-856-2020
Practice Address - Fax:626-962-0974
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47430207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75843ZMedicaid
W13790Medicare ID - Type Unspecified
CAZZZ75843ZMedicaid