Healthcare Provider Details

I. General information

NPI: 1134114663
Provider Name (Legal Business Name): MEHDI SOLEIMANPOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OLD NEWPORT BLVD SUITE #201
NEWPORT BEACH CA
92663-4291
US

IV. Provider business mailing address

PO BOX 60049
ARCADIA CA
91066-6049
US

V. Phone/Fax

Practice location:
  • Phone: 949-999-2950
  • Fax: 949-999-2943
Mailing address:
  • Phone: 626-698-7246
  • Fax: 626-447-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35038629S
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA35230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: