Healthcare Provider Details

I. General information

NPI: 1720720030
Provider Name (Legal Business Name): CDM MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 07/24/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 E COAST HWY STE 100
CORONA DEL MAR CA
92625-2257
US

IV. Provider business mailing address

2865 E COAST HWY STE 100
CORONA DEL MAR CA
92625-2257
US

V. Phone/Fax

Practice location:
  • Phone: 949-226-6111
  • Fax: 949-226-6044
Mailing address:
  • Phone: 949-226-6111
  • Fax: 949-226-6044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAVEH KARANDISH
Title or Position: CEO
Credential: MD
Phone: 949-226-6111