Provider Demographics
NPI:1497760219
Name:MOVAFEGH-JOORYABI, BIJAN (DO)
Entity Type:Individual
Prefix:DR
First Name:BIJAN
Middle Name:
Last Name:MOVAFEGH-JOORYABI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22921 TRITON WAY STE 125
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1236
Mailing Address - Country:US
Mailing Address - Phone:949-900-6992
Mailing Address - Fax:949-900-6993
Practice Address - Street 1:22921 TRITON WAY STE 125
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1236
Practice Address - Country:US
Practice Address - Phone:949-900-6992
Practice Address - Fax:949-900-6993
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012478207R00000X
CA20A10469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADB425YOtherPTAN
MIH11639Medicare UPIN