Healthcare Provider Details

I. General information

NPI: 1083770622
Provider Name (Legal Business Name): ALEXANDER B DEYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SAN MIGUEL #508
NEWPORT BEACH CA
92660
US

IV. Provider business mailing address

360 SAN MIGUEL #508
NEWPORT BEACH CA
92660
US

V. Phone/Fax

Practice location:
  • Phone: 949-720-9848
  • Fax: 949-720-9195
Mailing address:
  • Phone: 949-720-9848
  • Fax: 949-720-9195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG675681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: