Healthcare Provider Details

I. General information

NPI: 1407900624
Provider Name (Legal Business Name): ANOUSHIRAVAN EHYA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14516 HAWTHORNE BLVD
LAWNDALE CA
90260-1519
US

IV. Provider business mailing address

1315 N TUSTIN ST # I-383
ORANGE CA
92867-3905
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-3346
  • Fax: 714-547-3252
Mailing address:
  • Phone: 714-547-3346
  • Fax: 714-547-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA060345
License Number StateCA

VIII. Authorized Official

Name: DR. ANOUSH EHYA
Title or Position: PRESIDENT
Credential: MD
Phone: 714-547-3346