Provider Demographics
NPI:1548365232
Name:JOSS, DAVID R (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:JOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5500 E SANTA ANA CANYON RD
Mailing Address - Street 2:STE 255
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3154
Mailing Address - Country:US
Mailing Address - Phone:714-998-5677
Mailing Address - Fax:714-998-4288
Practice Address - Street 1:5500 E SANTA ANA CANYON RD
Practice Address - Street 2:STE 255
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3154
Practice Address - Country:US
Practice Address - Phone:714-998-5677
Practice Address - Fax:714-998-4288
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49533174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG49533OtherSTATE LICENSE
CAW15387Medicare ID - Type UnspecifiedGROUP MEDICARE#
CAA51394Medicare UPIN