Healthcare Provider Details

I. General information

NPI: 1619437704
Provider Name (Legal Business Name): ISMAIL DENIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15615 ALTON PKWY STE 220
IRVINE CA
92618-7305
US

IV. Provider business mailing address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-7419
US

V. Phone/Fax

Practice location:
  • Phone: 949-665-9136
  • Fax: 310-912-6743
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number194547
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number194547
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number194547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: