Healthcare Provider Details

I. General information

NPI: 1164365862
Provider Name (Legal Business Name): NEWPORT AESTHETIC SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 AVOCADO AVE STE 301
NEWPORT BEACH CA
92660-8729
US

IV. Provider business mailing address

1401 AVOCADO AVE STE 301
NEWPORT BEACH CA
92660-8729
US

V. Phone/Fax

Practice location:
  • Phone: 949-755-0575
  • Fax: 949-755-0580
Mailing address:
  • Phone: 949-755-0575
  • Fax: 949-755-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEYIAN PAYDAR
Title or Position: OWNER
Credential: MD
Phone: 949-755-0575