Healthcare Provider Details

I. General information

NPI: 1386751121
Provider Name (Legal Business Name): YACOOB VAHED P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 OLD NEWPORT BLVD STE 200
NEWPORT BEACH CA
92663-4257
US

IV. Provider business mailing address

447 OLD NEWPORT BLVD STE 200
NEWPORT BEACH CA
92663-4257
US

V. Phone/Fax

Practice location:
  • Phone: 949-650-3350
  • Fax: 949-650-1274
Mailing address:
  • Phone: 949-650-3350
  • Fax: 949-650-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA18422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: