Provider Demographics
NPI:1053636399
Name:MICHELE AMIRKHAN MD INC
Entity Type:Organization
Organization Name:MICHELE AMIRKHAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOJGAN
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:AMIRKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-667-7922
Mailing Address - Street 1:302 N TUSTIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3838
Mailing Address - Country:US
Mailing Address - Phone:714-667-7922
Mailing Address - Fax:
Practice Address - Street 1:1100 N TUSTIN AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3509
Practice Address - Country:US
Practice Address - Phone:714-667-7922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG080416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAO5D0940482OtherCLIA
KS200633070AMedicaid
CAG80416OtherMEDICARE ID
CAG80416OtherMEDICARE ID
KS200633070AMedicaid
CAO5D0940482OtherCLIA