Provider Demographics
NPI:1659767341
Name:LEG AND VEIN INSTITUTE, INC
Entity Type:Organization
Organization Name:LEG AND VEIN INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAIF
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-679-5347
Mailing Address - Street 1:1601 DOVE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2433
Mailing Address - Country:US
Mailing Address - Phone:949-679-5347
Mailing Address - Fax:866-335-0887
Practice Address - Street 1:1601 DOVE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2433
Practice Address - Country:US
Practice Address - Phone:949-679-5347
Practice Address - Fax:866-335-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA788432085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty