Provider Demographics
NPI:1235165226
Name:GOLDSTEIN, NEIL K (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:K
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:32386 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-7134
Mailing Address - Country:US
Mailing Address - Phone:602-799-8016
Mailing Address - Fax:
Practice Address - Street 1:12827 HARBOR BLVD STE G1
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5839
Practice Address - Country:US
Practice Address - Phone:714-534-1680
Practice Address - Fax:714-534-1685
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG845752085R0204X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ832221Medicaid
CAHK516XMedicare UPIN
AZG98694Medicare UPIN
AZ832221Medicaid