Provider Demographics
NPI:1578659405
Name:PAIKAL, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:PAIKAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:PAIKAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:16661 VENTURA BLVD
Mailing Address - Street 2:SUITE 522
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1914
Mailing Address - Country:US
Mailing Address - Phone:818-981-1663
Mailing Address - Fax:818-981-1489
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 522
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-981-1663
Practice Address - Fax:818-981-1489
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76744207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A767440Medicaid
CAW18203Medicare PIN
CA00A767440Medicaid