Provider Demographics
NPI:1851437792
Name:TAL DAVID, MD, INC
Entity Type:Organization
Organization Name:TAL DAVID, MD, INC
Other - Org Name:TAL S. DAVID, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-571-9500
Mailing Address - Street 1:5471 KEARNY VILLA RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1143
Mailing Address - Country:US
Mailing Address - Phone:858-571-9500
Mailing Address - Fax:858-715-4946
Practice Address - Street 1:5471 KEARNY VILLA RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1143
Practice Address - Country:US
Practice Address - Phone:858-571-9500
Practice Address - Fax:858-715-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69504207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA69504COtherMEDICARE PROVIDER ID
CAW17895OtherMEDICARE GROUP NO.
CAW17895OtherMEDICARE PTAN
CAH03615Medicare UPIN