Provider Demographics
NPI:1083970776
Name:FERDOUS F. KAZEMI, MD
Entity Type:Organization
Organization Name:FERDOUS F. KAZEMI, MD
Other - Org Name:FERDOUS F. KAZEMI, MD INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:FERDOUS
Authorized Official - Middle Name:F
Authorized Official - Last Name:KAZEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-966-6666
Mailing Address - Street 1:1220 HEMLOCK WAY
Mailing Address - Street 2:STE. 105B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3600
Mailing Address - Country:US
Mailing Address - Phone:714-966-6666
Mailing Address - Fax:714-966-0316
Practice Address - Street 1:1220 HEMLOCK WAY
Practice Address - Street 2:STE. 105B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3600
Practice Address - Country:US
Practice Address - Phone:714-966-6666
Practice Address - Fax:714-966-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32367208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A323670Medicaid