Provider Demographics
NPI:1831140938
Name:WASS, ADAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:M
Last Name:WASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 DOW AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7242
Mailing Address - Country:US
Mailing Address - Phone:714-665-1600
Mailing Address - Fax:
Practice Address - Street 1:722 BAKER ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4320
Practice Address - Country:US
Practice Address - Phone:714-557-6300
Practice Address - Fax:714-996-9567
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A870700Medicaid
CAI41771Medicare UPIN
CA00A870700Medicaid
CAWA87070DMedicare PIN