Provider Demographics
NPI:1316042534
Name:AFAGH KHORASHADI,M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:AFAGH KHORASHADI,M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AFAGH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHORASHADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-474-4567
Mailing Address - Street 1:22 ODYSSEY STE 230
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-7700
Mailing Address - Country:US
Mailing Address - Phone:949-474-4567
Mailing Address - Fax:949-474-4277
Practice Address - Street 1:22 ODYSSEY STE 230
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-7700
Practice Address - Country:US
Practice Address - Phone:949-474-4567
Practice Address - Fax:949-474-4277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A621010OtherMEDI-CAL PROVIDER NUMBER