Provider Demographics
NPI:1619201167
Name:SAHA, MANISH (MD)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:
Last Name:SAHA
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 1:500 SUPERIOR AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3677
Mailing Address - Country:US
Mailing Address - Phone:949-791-3006
Mailing Address - Fax:949-791-3060
Practice Address - Street 1:500 SUPERIOR AVE STE 160
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3677
Practice Address - Country:US
Practice Address - Phone:949-791-3006
Practice Address - Fax:949-791-3060
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259762207Q00000X
CODR.0062946207Q00000X
CAC167670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03306558Medicaid
NYJ400041287Medicare PIN
NY03306558Medicaid