Healthcare Provider Details

I. General information

NPI: 1912176264
Provider Name (Legal Business Name): DR. M. FORGHANI S. C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 GARDEN GROVE BLVD SUITE 601
GARDEN GROVE CA
92843-1901
US

IV. Provider business mailing address

12665 GARDEN GROVE BLVD SUITE 601
GARDEN GROVE CA
92843-1901
US

V. Phone/Fax

Practice location:
  • Phone: 714-537-1387
  • Fax: 714-537-0917
Mailing address:
  • Phone: 714-537-1387
  • Fax: 714-537-0917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number20A8699
License Number StateCA

VIII. Authorized Official

Name: MEHRDAD FORGHANI-ARANI
Title or Position: PRESIDENT
Credential: DO
Phone: 714-537-1387