Provider Demographics
NPI:1073654927
Name:DOBKIN, MARK S (MA, FAAA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:DOBKIN
Suffix:
Gender:M
Credentials:MA, FAAA
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:SUITE A
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:949-645-8750
Practice Address - Street 1:124 BROADWAY
Practice Address - Street 2:SUITE A
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:949-645-8750
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU864231H00000X
CAHA1668237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3144612Medicaid
CA3144612Medicaid