Provider Demographics
NPI:1902135940
Name:DAVID B. OKUN M.D. INC.
Entity Type:Organization
Organization Name:DAVID B. OKUN M.D. INC.
Other - Org Name:DAVID B. OKUN M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-770-8168
Mailing Address - Street 1:24953 PASEO DE VALENCIA
Mailing Address - Street 2:#25 B
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4342
Mailing Address - Country:US
Mailing Address - Phone:949-770-8168
Mailing Address - Fax:949-770-2991
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:#25 B
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4342
Practice Address - Country:US
Practice Address - Phone:949-770-8168
Practice Address - Fax:949-770-2991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID B. OKUN M.D, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-22
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29859207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G298590Medicaid
CAG29859Medicare PIN
CA00G298590Medicaid