Provider Demographics
NPI:1144343146
Name:DAVIDSON, JOSHUA MICHAEL IAN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:MICHAEL IAN
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:JOSHUA
Other - Middle Name:M
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:502 TORRANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3413
Mailing Address - Country:US
Mailing Address - Phone:310-792-8393
Mailing Address - Fax:310-316-2814
Practice Address - Street 1:502 TORRANCE BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3413
Practice Address - Country:US
Practice Address - Phone:310-792-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88990207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD692ZMedicare PIN