Provider Demographics
NPI:1326306044
Name:HUNTINGTON BEACH SURGICAL ARTS LLC
Entity Type:Organization
Organization Name:HUNTINGTON BEACH SURGICAL ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEHKORDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-894-8880
Mailing Address - Street 1:15039 GOLDENWEST ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2710
Mailing Address - Country:US
Mailing Address - Phone:714-894-8880
Mailing Address - Fax:714-894-7772
Practice Address - Street 1:15039 GOLDENWEST ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2710
Practice Address - Country:US
Practice Address - Phone:714-894-8880
Practice Address - Fax:714-894-7772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HB SURGICAL ARTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-01
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA283239261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
F92275Medicare PIN