Individual provider Active NPI

David L.J. Wardle, M.D. FRCS

  • Plastic Surgery Physician
  • Newport Beach, CA
National Provider Identifier
1790878601
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
A51102 Issued in CA
Practice address
360 San Miguel Dr Ste 406
Newport Beach, CA 92660-7822
Phone
(949) 719-2826
Fax
(949) 759-5458
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X A51102 CA Primary

Addresses

Primary practice location

360 San Miguel Dr Ste 406
Newport Beach, CA 92660-7822

Mailing address

360 San Miguel Dr Ste 406
Newport Beach, CA 92660-7822
Phone (949) 719-2826

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A51102CAMDPlastic Surgery Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790878601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 SAN MIGUEL DR STE 406",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607822",
            "telephone_number": "949-719-2826",
            "fax_number": "949-759-5458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 SAN MIGUEL DR STE 406",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607822",
            "telephone_number": "949-719-2826",
            "fax_number": "949-759-5458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARDLE",
        "first_name": "DAVID",
        "middle_name": "L.J.",
        "name_prefix": "Dr.",
        "credential": "M.D. FRCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "A51102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.