Provider Demographics
NPI:1164699880
Name:VEIN DOCTOR MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:VEIN DOCTOR MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-500-7714
Mailing Address - Street 1:1945 E 17TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6862
Mailing Address - Country:US
Mailing Address - Phone:714-500-7714
Mailing Address - Fax:714-500-7713
Practice Address - Street 1:1945 E 17TH ST STE 107
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6862
Practice Address - Country:US
Practice Address - Phone:714-500-7714
Practice Address - Fax:714-500-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35672202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty