Provider Demographics
NPI:1487822326
Name:BABAK PEZESHKI, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BABAK PEZESHKI, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:PEZESHKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-645-2800
Mailing Address - Street 1:520 SUPERIOR AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3637
Mailing Address - Country:US
Mailing Address - Phone:949-645-2800
Mailing Address - Fax:949-645-2810
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-645-2800
Practice Address - Fax:949-645-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty