Healthcare Provider Details

I. General information

NPI: 1821155326
Provider Name (Legal Business Name): TENGIS RIZNIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 TECHNOLOGY DR
IRVINE CA
92618-2302
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 949-923-3200
  • Fax: 949-923-3550
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA86212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: