Provider Demographics
NPI:1730499799
Name:SINA MEDICAL GROUP
Entity Type:Organization
Organization Name:SINA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-972-2200
Mailing Address - Street 1:1125 E 17TH ST STE N461
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2270
Mailing Address - Country:US
Mailing Address - Phone:714-972-2200
Mailing Address - Fax:
Practice Address - Street 1:1125 E 17TH ST STE N461
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2270
Practice Address - Country:US
Practice Address - Phone:714-972-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26980111N00000X
KS20A6766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty