Healthcare Provider Details

I. General information

NPI: 1720233976
Provider Name (Legal Business Name): AFSHIN ZANDPOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/03/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14662 NEWPORT AVE
TUSTIN CA
92780-6064
US

IV. Provider business mailing address

4790 IRVINE BLVD
IRVINE CA
92620-1973
US

V. Phone/Fax

Practice location:
  • Phone: 949-257-2424
  • Fax:
Mailing address:
  • Phone: 949-257-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA112909
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA112909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: