Provider Demographics
NPI:1790723351
Name:S. MYRON GOLDSTEIN MD FACS INC
Entity Type:Organization
Organization Name:S. MYRON GOLDSTEIN MD FACS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-995-0893
Mailing Address - Street 1:431 N TUSTIN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3821
Mailing Address - Country:US
Mailing Address - Phone:949-273-7300
Mailing Address - Fax:714-664-0225
Practice Address - Street 1:431 N TUSTIN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3821
Practice Address - Country:US
Practice Address - Phone:949-273-7300
Practice Address - Fax:714-664-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26456208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17355Medicare PIN
CAW17355Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAB51029Medicare UPIN