Provider Demographics
NPI:1922049188
Name:DASTMALCHI, OWRANG (DO)
Entity Type:Individual
Prefix:DR
First Name:OWRANG
Middle Name:
Last Name:DASTMALCHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23141 VERDUGO DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1341
Mailing Address - Country:US
Mailing Address - Phone:949-215-5055
Mailing Address - Fax:
Practice Address - Street 1:23141 VERDUGO DR STE 201
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1341
Practice Address - Country:US
Practice Address - Phone:949-215-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8369208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB209527Medicare PIN
CAW17904Medicare PIN
CAW20A8369AMedicare PIN