Healthcare Provider Details

I. General information

NPI: 1235165226
Provider Name (Legal Business Name): NEIL K GOLDSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 REYNOLDS AVE STE 110
IRVINE CA
92614-5562
US

IV. Provider business mailing address

32386 ORCHARD DR
SAN JUAN CAPISTRANO CA
92675-7134
US

V. Phone/Fax

Practice location:
  • Phone: 949-398-7472
  • Fax: 949-209-0407
Mailing address:
  • Phone: 602-799-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG84575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: