Provider Demographics
NPI:1508814716
Name:MOAYERI, HOUSHANG (MD)
Entity Type:Individual
Prefix:MR
First Name:HOUSHANG
Middle Name:
Last Name:MOAYERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17822 BEACH BLVD
Mailing Address - Street 2:SUITE 343
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7500
Mailing Address - Country:US
Mailing Address - Phone:714-842-7779
Mailing Address - Fax:714-847-9334
Practice Address - Street 1:17822 BEACH BLVD
Practice Address - Street 2:SUITE 343
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7500
Practice Address - Country:US
Practice Address - Phone:714-842-7779
Practice Address - Fax:714-847-9334
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37168207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A371681Medicaid
CAA37168Medicare ID - Type Unspecified
CA00A371681Medicaid