Healthcare Provider Details

I. General information

NPI: 1730405440
Provider Name (Legal Business Name): BORYS GVOZDYEV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 BROOKHURST ST STE 2600
FOUNTAIN VALLEY CA
92708-6728
US

IV. Provider business mailing address

17870 NEWHOPE ST STE 104-197
FOUNTAIN VALLEY CA
92708-5439
US

V. Phone/Fax

Practice location:
  • Phone: 949-988-0000
  • Fax: 949-988-4000
Mailing address:
  • Phone: 949-342-8892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA144225
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA144225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: