Healthcare Provider Details

I. General information

NPI: 1376528489
Provider Name (Legal Business Name): DAVID DEYHIMY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24451 HEALTH CENTER DR
LAGUNA HILLS CA
92653-3689
US

IV. Provider business mailing address

PO BOX 10429
NEWPORT BEACH CA
92658-0429
US

V. Phone/Fax

Practice location:
  • Phone: 949-837-4500
  • Fax: 949-837-4621
Mailing address:
  • Phone: 949-417-1812
  • Fax: 949-417-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberA82776
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA827760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: