Healthcare Provider Details

I. General information

NPI: 1386962686
Provider Name (Legal Business Name): KAZI REZAI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18672 FLORIDA ST SUITE 302-B
HUNTINGTON BEACH CA
92648-1925
US

IV. Provider business mailing address

18672 FLORIDA ST SUITE 302-B
HUNTINGTON BEACH CA
92648-1925
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-0691
  • Fax:
Mailing address:
  • Phone: 714-375-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A12157
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A12157
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number20A12157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: