Healthcare Provider Details

I. General information

NPI: 1083829956
Provider Name (Legal Business Name): SIAMAK MILANCHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SIAMAK MILANCHI ANARKOOLI

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 SAND CANYON AVE STE 604
IRVINE CA
92618-3706
US

IV. Provider business mailing address

PO BOX 52435
IRVINE CA
92619-2435
US

V. Phone/Fax

Practice location:
  • Phone: 949-429-0268
  • Fax: 949-420-2180
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA92723
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA92723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: