Provider Demographics
NPI:1588838445
Name:SYRUS RAYHAN MD INC
Entity Type:Organization
Organization Name:SYRUS RAYHAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-847-1277
Mailing Address - Street 1:17822 BEACH BLVD STE 136
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7178
Mailing Address - Country:US
Mailing Address - Phone:714-847-1277
Mailing Address - Fax:714-843-2000
Practice Address - Street 1:17822 BEACH BLVD STE 136
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7178
Practice Address - Country:US
Practice Address - Phone:714-847-1277
Practice Address - Fax:714-843-2000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYRUS RAYHAN MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25892174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25892OtherBLUE CROSS
CAA25892OtherBLUE CROSS
CAWA83302AMedicare UPIN