Healthcare Provider Details

I. General information

NPI: 1841600764
Provider Name (Legal Business Name): SAIF SIDDIQI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CANYON TER
IRVINE CA
92603-0227
US

IV. Provider business mailing address

28 CANYON TER
IRVINE CA
92603-0227
US

V. Phone/Fax

Practice location:
  • Phone: 714-425-5937
  • Fax:
Mailing address:
  • Phone: 714-425-5937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA78843
License Number StateCA

VIII. Authorized Official

Name: DR. SAIF SIDDIQI
Title or Position: PRESIDENT
Credential: MD
Phone: 714-425-5937