Healthcare Provider Details

I. General information

NPI: 1710910047
Provider Name (Legal Business Name): SIMON B RAYHANABAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3791 KATELLA AVE #201
LOS ALAMITOS CA
90720-3105
US

IV. Provider business mailing address

3791 KATELLA AVE STE 201
LOS ALAMITOS CA
90720-2016
US

V. Phone/Fax

Practice location:
  • Phone: 562-596-6736
  • Fax: 562-596-5387
Mailing address:
  • Phone: 562-596-6736
  • Fax: 562-596-5387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA36844
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA36844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: