Provider Demographics
NPI:1750027546
Name:MAHTAB K YOUSEFI, M.D.
Entity Type:Organization
Organization Name:MAHTAB K YOUSEFI, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHTAB
Authorized Official - Middle Name:KARKHANE
Authorized Official - Last Name:YOUSEFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-570-9415
Mailing Address - Street 1:427 E 17TH ST # F249
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3201
Mailing Address - Country:US
Mailing Address - Phone:949-570-9415
Mailing Address - Fax:949-570-9413
Practice Address - Street 1:301 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1995
Practice Address - Country:US
Practice Address - Phone:949-624-2734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit