Provider Demographics
NPI:1124036462
Name:GHAZINOOR, SHAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAYA
Middle Name:
Last Name:GHAZINOOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EXECUTIVE PARK STE 155
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4733
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:800-409-7005
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-645-3534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA763052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124036462Medicaid
CA00A763050OtherBS OF CA
CA00A763050Medicaid
CAWA76305FMedicare PIN
CAI 59842Medicare UPIN
CA00A763056Medicare PIN
CAWA76305DMedicare PIN
CA00A763051Medicare PIN
CA00A763054Medicare PIN
CA00A763050OtherBS OF CA
CAWA76305EMedicare PIN
CA00A763057Medicare PIN
CABR053YMedicare PIN
CA00A763050Medicaid
CA00A763052Medicare PIN
CA00A763055Medicare PIN
CABR053ZMedicare PIN
CAWA76305CMedicare PIN
CA00A763050Medicare PIN
CA00A763053Medicare PIN