Healthcare Provider Details

I. General information

NPI: 1558577163
Provider Name (Legal Business Name): PONEH RAHIMI, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/12/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 N 500 E
LOGAN UT
84341-2400
US

IV. Provider business mailing address

PO BOX 2636
MISSION VIEJO CA
92690-0636
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-2536
  • Fax: 949-388-8013
Mailing address:
  • Phone: 949-364-2536
  • Fax: 949-388-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. PONEH RAHIMI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-364-2536