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General NPI Number Information
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NPI Number | 1205375094
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Entity Type | Organization
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Legal Business Name | DR KAZI CLINIC INC
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 18672 FLORIDA ST 302-B
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-1925
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Country | US
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Telephone | 805-314-5542
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Fax | 805-466-4229
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Provider Business Mailing Address
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Address Line | 18672 FLORIDA ST 302-B
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-1925
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Country | US
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Telephone | 805-314-5542
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Fax | 805-466-4229
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAZI REZAI
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Credential | D.O.
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Telephone | 805-314-5542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 20A12157
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License Number State | CA
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