MEDICARE: MR. YACOOB VAHED P.A.-C

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	363AS0400X	Surgical Physician Assistant	PA18422	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	330204983	OTHER	CA	TAX ID
2	1750339479	OTHER	CA	NPI - GROUP
3	PA18422	OTHER	CA	LISC.
4	W10327	OTHER	CA	MCR GROUP ID

General Provider Information

NPI Number	:	1386751121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YACOOB VAHED P.A.-C

Provider Business Mailing Address
First Line	:	447 OLD NEWPORT BLVD STE 200
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4257
Country	:	US
Telephone Number	:	949-650-3350
Fax Number	:	949-650-1274

Provider Business Practice Location Address
First Line	:	447 OLD NEWPORT BLVD STE 200
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4257
Country	:	US
Telephone Number	:	949-650-3350
Fax Number	:	949-650-1274

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	11/30/2021

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Directions to “ MR. YACOOB VAHED P.A.-C” Practice Location

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