MEDICARE: DR. RON YARON GOLDSTEIN M.D.

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	261QM2500X	Medical Specialty Clinic/Center	G79669	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G 00070	OTHER	CA	MEDICARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1588848816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RON YARON GOLDSTEIN M.D.

Provider Business Mailing Address
First Line	:	902 N GRAND AVE
Second Line	:	SUITE 204
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4218
Country	:	US
Telephone Number	:	714-564-8210
Fax Number	:	714-564-8306

Provider Business Practice Location Address
First Line	:	3000 W MACARTHUR BLVD STE 600
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6982
Country	:	US
Telephone Number	:	714-564-8210
Fax Number	:	714-564-8306

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

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	01/09/2020

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