1205826583 NPI number — DR. KAMRAN HAGHIGHAT MD

Table of content: DR. KAMRAN HAGHIGHAT MD (NPI 1205826583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205826583 NPI number — DR. KAMRAN HAGHIGHAT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGHIGHAT
Provider First Name:
KAMRAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205826583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2742 DOW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSTIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92780-7242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-665-1600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3010 W ORANGE AVE
Provider Second Line Business Practice Location Address:
STE. 302
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92804-3169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-826-1200
Provider Business Practice Location Address Fax Number:
714-229-5399
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A56353 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: A56353 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A563530 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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