Healthcare Provider Details

I. General information

NPI: 1891386843
Provider Name (Legal Business Name): HOSSEINI MD MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25982 PALA STE 140
MISSION VIEJO CA
92691-6724
US

IV. Provider business mailing address

13512 MOORE ST
CERRITOS CA
90703-2309
US

V. Phone/Fax

Practice location:
  • Phone: 949-407-4404
  • Fax: 949-407-4647
Mailing address:
  • Phone: 949-407-4404
  • Fax: 949-407-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: TINA NGO
Title or Position: CREDENTIAL REP
Credential: CPC
Phone: 657-900-6500