MEDICARE: DR. ALIREZA KHAZAEIZADEH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A100885	CA

General Provider Information

NPI Number	:	1346411477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALIREZA KHAZAEIZADEH MD

Provider Business Mailing Address
First Line	:	601 S BEACH BLVD
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3102
Country	:	US
Telephone Number	:	949-600-7733
Fax Number	:	949-600-8822

Provider Business Practice Location Address
First Line	:	601 S BEACH BLVD
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3102
Country	:	US
Telephone Number	:	949-600-7733
Fax Number	:	949-600-8822

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	02/17/2026

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