Provider Demographics
NPI:1114025780
Name:SADRI, EHSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EHSAN
Middle Name:
Last Name:SADRI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:888 S DISNEYLAND DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1847
Mailing Address - Country:US
Mailing Address - Phone:949-642-3100
Mailing Address - Fax:949-642-4900
Practice Address - Street 1:361 HOSPITAL RD
Practice Address - Street 2:SUITE 327
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3522
Practice Address - Country:US
Practice Address - Phone:949-642-3100
Practice Address - Fax:949-642-4900
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA87053207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI11131Medicare UPIN
WA87053CMedicare PIN