Provider Demographics
NPI:1609236033
Name:MOTAMEDIAN, HESSAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HESSAM
Middle Name:
Last Name:MOTAMEDIAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PALATINE
Mailing Address - Street 2:APT 428
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1626
Mailing Address - Country:US
Mailing Address - Phone:310-800-0535
Mailing Address - Fax:
Practice Address - Street 1:23232 PERALTA DR
Practice Address - Street 2:STE 114
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1436
Practice Address - Country:US
Practice Address - Phone:949-342-5053
Practice Address - Fax:949-342-5053
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist