Provider Demographics
NPI:1679738322
Name:BAHRAM ALAVYNEJAD MD INC
Entity Type:Organization
Organization Name:BAHRAM ALAVYNEJAD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAVYNEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-463-2389
Mailing Address - Street 1:PO BOX 11553
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5033
Mailing Address - Country:US
Mailing Address - Phone:949-463-2389
Mailing Address - Fax:
Practice Address - Street 1:235 E IMPERIAL HWY
Practice Address - Street 2:STE B
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4982
Practice Address - Country:US
Practice Address - Phone:949-463-2389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74844207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty