Provider Demographics
NPI:1790763217
Name:SEYED H. SHAHROKNI, MD, INC.
Entity Type:Organization
Organization Name:SEYED H. SHAHROKNI, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYED
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAHROKNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-859-0400
Mailing Address - Street 1:27758 SANTA MARGARITA PKWY
Mailing Address - Street 2:#409
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6709
Mailing Address - Country:US
Mailing Address - Phone:949-364-5716
Mailing Address - Fax:949-364-5777
Practice Address - Street 1:27725 SANTA MARGARITA PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6704
Practice Address - Country:US
Practice Address - Phone:949-462-3999
Practice Address - Fax:949-462-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA67310OtherSTATE LICENSE