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General NPI Number Information
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NPI Number | 1508158783
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Entity Type | Organization
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Legal Business Name | ASHKAN ETEMADIAN MD INC
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 05/06/2011
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Provider Practice Location Address
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Address Line | 1 HOAG DR
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4162
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Country | US
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Telephone | 949-764-4624
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Fax |
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Provider Business Mailing Address
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Address Line | 32565 B GOLDEN LANTERN #167
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City | DANA POINT
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State | CA
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Zip | 92629
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Country | US
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Telephone | 949-701-2973
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ASHKAN ETEMADIAN
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Credential | MD
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Telephone | 949-701-2973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A105385
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License Number State | CA
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