Provider Demographics
NPI:1205826583
Name:HAGHIGHAT, KAMRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:
Last Name:HAGHIGHAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 DOW AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7242
Mailing Address - Country:US
Mailing Address - Phone:714-665-1600
Mailing Address - Fax:
Practice Address - Street 1:3010 W ORANGE AVE
Practice Address - Street 2:STE. 302
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3169
Practice Address - Country:US
Practice Address - Phone:714-826-1200
Practice Address - Fax:714-229-5399
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56353207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A563530Medicaid
CA00A563530Medicaid
CAEO325ZMedicare PIN
CAG94216Medicare UPIN