Healthcare Provider Details

I. General information

NPI: 1669589750
Provider Name (Legal Business Name): HOWARD S SIEGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12062 VALLEY VIEW ST SUITE 200
GARDEN GROVE CA
92845-1737
US

IV. Provider business mailing address

PO BOX 19065
ANAHEIM CA
92817-9065
US

V. Phone/Fax

Practice location:
  • Phone: 714-908-5636
  • Fax: 714-908-5616
Mailing address:
  • Phone: 714-904-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA50183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: