Healthcare Provider Details

I. General information

NPI: 1124535406
Provider Name (Legal Business Name): BAVAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18632 BEACH BLVD STE 100
HUNTINGTON BEACH CA
92648-2047
US

IV. Provider business mailing address

18632 BEACH BLVD STE 100
HUNTINGTON BEACH CA
92648-2047
US

V. Phone/Fax

Practice location:
  • Phone: 714-962-3633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: BAVAND YOUSSEFZADEH
Title or Position: DELEGATED OFFICIAL
Credential: DO
Phone: 858-455-6800