Provider Demographics
NPI:1629324140
Name:HOSSEINI, ALIREZA (MD)
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALIREZA
Other - Middle Name:
Other - Last Name:HOSSEINI-KHALILI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13512 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2309
Mailing Address - Country:US
Mailing Address - Phone:949-407-4404
Mailing Address - Fax:
Practice Address - Street 1:25982 PALA STE 140
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6724
Practice Address - Country:US
Practice Address - Phone:310-328-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA142579207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty