Provider Demographics
NPI:1588848816
Name:GOLDSTEIN, RON YARON (MD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:YARON
Last Name:GOLDSTEIN
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 1:902 N GRAND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4218
Mailing Address - Country:US
Mailing Address - Phone:714-564-8210
Mailing Address - Fax:714-564-8306
Practice Address - Street 1:3000 W MACARTHUR BLVD STE 600
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6982
Practice Address - Country:US
Practice Address - Phone:714-564-8210
Practice Address - Fax:714-564-8306
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79669261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG 00070OtherMEDICARE PROVIDER NUMBER