Provider Demographics
NPI:1407900624
Name:ANOUSHIRAVAN EHYA, INC
Entity Type:Organization
Organization Name:ANOUSHIRAVAN EHYA, INC
Other - Org Name:INDEPENDENT ORTHO SURGERY INST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANOUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:EHYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-547-3346
Mailing Address - Street 1:1315 N TUSTIN ST # I-383
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3905
Mailing Address - Country:US
Mailing Address - Phone:714-547-3346
Mailing Address - Fax:714-547-3252
Practice Address - Street 1:14516 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1519
Practice Address - Country:US
Practice Address - Phone:714-547-3346
Practice Address - Fax:714-547-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA060345207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH38576Medicare UPIN