Provider Demographics
NPI:1629578299
Name:DOBKIN, ADAM BENJAMIN (AUD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:BENJAMIN
Last Name:DOBKIN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2868
Mailing Address - Country:US
Mailing Address - Phone:949-645-0886
Mailing Address - Fax:
Practice Address - Street 1:124 BROADWAY
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2868
Practice Address - Country:US
Practice Address - Phone:949-645-0886
Practice Address - Fax:949-645-0886
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU3275231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist