Healthcare Provider Details

I. General information

NPI: 1891715009
Provider Name (Legal Business Name): GARY STEVEN FELDMAN M.B.CHB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 IRVINE CENTER DR STE 104
IRVINE CA
92604-3334
US

IV. Provider business mailing address

PO BOX 12315
ORANGE CA
92859-8315
US

V. Phone/Fax

Practice location:
  • Phone: 949-446-8990
  • Fax: 949-446-8535
Mailing address:
  • Phone: 949-446-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License NumberA86656
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberA86656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: