Provider Demographics
NPI:1205380532
Name:EXAM SPECIALIST MEDICAL GROUP
Entity Type:Organization
Organization Name:EXAM SPECIALIST MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:SEEYAM
Authorized Official - Middle Name:NOBANDEGANI
Authorized Official - Last Name:TEIMOORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-505-2093
Mailing Address - Street 1:PO BOX 6646
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-6646
Mailing Address - Country:US
Mailing Address - Phone:714-505-2093
Mailing Address - Fax:
Practice Address - Street 1:17821 17TH ST STE 250
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2173
Practice Address - Country:US
Practice Address - Phone:714-505-2093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118840174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty