Healthcare Provider Details

I. General information

NPI: 1316042534
Provider Name (Legal Business Name): AFAGH KHORASHADI,M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ODYSSEY STE 230
IRVINE CA
92618-7700
US

IV. Provider business mailing address

22 ODYSSEY STE 230
IRVINE CA
92618-7700
US

V. Phone/Fax

Practice location:
  • Phone: 949-474-4567
  • Fax: 949-474-4277
Mailing address:
  • Phone: 949-474-4567
  • Fax: 949-474-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: AFAGH KHORASHADI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-474-4567