Provider Demographics
NPI:1932117462
Name:BLISS, DAVID WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:BLISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:CHILDREN'S HOSPITAL LOS ANGELES, MS 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-2276
Mailing Address - Fax:323-361-3534
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL LOS ANGELESM MS 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2276
Practice Address - Fax:323-361-3534
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD232192086S0120X
CAG832342086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287477Medicaid
F66028Medicare UPIN