Provider Demographics
NPI:1922320340
Name:MORIDANI, BIJAN BAGHER (MD)
Entity Type:Individual
Prefix:DR
First Name:BIJAN
Middle Name:BAGHER
Last Name:MORIDANI
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 1:803 AVENIDA PRESIDIO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2215
Mailing Address - Country:US
Mailing Address - Phone:949-525-1674
Mailing Address - Fax:
Practice Address - Street 1:803 AVENIDA PRESIDIO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-2215
Practice Address - Country:US
Practice Address - Phone:949-525-1674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology