Healthcare Provider Details

I. General information

NPI: 1518983899
Provider Name (Legal Business Name): AMIR K. GHIASSI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W STEWART DR
ORANGE CA
92868-3849
US

IV. Provider business mailing address

24422 AVENIDA DE LA CARLOTA STE 275
LAGUNA HILLS CA
92653-3669
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-9111
  • Fax:
Mailing address:
  • Phone: 949-829-8299
  • Fax: 949-829-8298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC52272
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC52272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: