Healthcare Provider Details

I. General information

NPI: 1003031956
Provider Name (Legal Business Name): SEMIRA BAYATI, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20311 SW BIRCH ST SUITE 200
NEWPORT BEACH CA
92660-1777
US

IV. Provider business mailing address

20311 SW BIRCH ST SUITE 200
NEWPORT BEACH CA
92660-1777
US

V. Phone/Fax

Practice location:
  • Phone: 949-756-0400
  • Fax: 949-756-0428
Mailing address:
  • Phone: 949-756-0400
  • Fax: 949-756-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SEMIRA BAYATI
Title or Position: PRESIDENT
Credential: MD
Phone: 949-756-0400