Provider Demographics
NPI:1003031956
Name:SEMIRA BAYATI, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SEMIRA BAYATI, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:SEMIRA BAYATI MD A PROFESSIONAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-756-0400
Mailing Address - Street 1:20311 SW BIRCH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1777
Mailing Address - Country:US
Mailing Address - Phone:949-756-0400
Mailing Address - Fax:949-756-0428
Practice Address - Street 1:20311 SW BIRCH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1777
Practice Address - Country:US
Practice Address - Phone:949-756-0400
Practice Address - Fax:949-756-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG84241OtherMEDICAL LICENSE
CAG84241OtherMEDICAL LICENSE