Healthcare Provider Details

I. General information

NPI: 1972666840
Provider Name (Legal Business Name): HAMID MIR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17631 17TH ST UNIT 200
TUSTIN CA
92780-7943
US

IV. Provider business mailing address

220 NEWPORT CENTER DR # 11-282
NEWPORT BEACH CA
92660-7506
US

V. Phone/Fax

Practice location:
  • Phone: 949-749-0055
  • Fax: 949-226-7210
Mailing address:
  • Phone: 949-749-0055
  • Fax: 949-226-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA84242
License Number StateCA

VIII. Authorized Official

Name: HAMID R MIR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-749-0055