Provider Demographics
NPI:1427158245
Name:DAVID, RICHARD D (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:DAVID
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749267
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-9267
Mailing Address - Country:US
Mailing Address - Phone:818-990-5020
Mailing Address - Fax:818-990-8549
Practice Address - Street 1:5522 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-3437
Practice Address - Country:US
Practice Address - Phone:818-990-5020
Practice Address - Fax:818-990-8549
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58038208800000X
MT14752208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00705287OtherMEDICARE RR
CADG3479OtherMCRR GROUP PTAN
CA00G580380Medicaid
CADG3479OtherMCRR GROUP PTAN
CAWG58038CMedicare ID - Type Unspecified
203177408OtherTIN