Provider Demographics
NPI:1174543474
Name:ATKIN, DAVE (MD)
Entity type:Individual
Prefix:
First Name:DAVE
Middle Name:
Last Name:ATKIN
Suffix:
Gender:M
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 1230
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-1230
Mailing Address - Country:US
Mailing Address - Phone:415-642-0707
Mailing Address - Fax:415-550-1566
Practice Address - Street 1:1580 VALENCIA ST
Practice Address - Street 2:SUITE 703
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4423
Practice Address - Country:US
Practice Address - Phone:415-642-0707
Practice Address - Fax:415-550-1566
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65707207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG00526Medicare UPIN
CA00G657071Medicare PIN