Provider Demographics
NPI:1629184536
Name:KAZEMI, FERDOUS F (MD)
Entity Type:Individual
Prefix:DR
First Name:FERDOUS
Middle Name:F
Last Name:KAZEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 HEMLOCK WAY
Mailing Address - Street 2:STE 105-B BRISTOL SOUTH CONST CENTER
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707
Mailing Address - Country:US
Mailing Address - Phone:714-966-6666
Mailing Address - Fax:714-966-0316
Practice Address - Street 1:1220 HEMLOCK WAY
Practice Address - Street 2:STE 105-B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707
Practice Address - Country:US
Practice Address - Phone:714-966-6666
Practice Address - Fax:714-966-0316
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA32367208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A323670Medicaid
CA00A323670Medicaid