Provider Demographics
NPI:1245507417
Name:VICTOR S DORODNY MD INC
Entity type:Organization
Organization Name:VICTOR S DORODNY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:DORODNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1828-367-6369
Mailing Address - Street 1:30765 PACIFIC COAST HWY STE 285
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3646
Mailing Address - Country:US
Mailing Address - Phone:828-367-6369
Mailing Address - Fax:
Practice Address - Street 1:30765 PACIFIC COAST HWY STE 285
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3646
Practice Address - Country:US
Practice Address - Phone:182-836-7636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35905208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty