Provider Demographics
NPI:1972507697
Name:SELVAN, ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:SELVAN
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 1:1200 N TUSTIN AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3534
Mailing Address - Country:US
Mailing Address - Phone:714-543-9855
Mailing Address - Fax:714-543-8553
Practice Address - Street 1:1200 N TUSTIN AVE
Practice Address - Street 2:STE 260
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3534
Practice Address - Country:US
Practice Address - Phone:714-543-9855
Practice Address - Fax:714-543-8553
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2007-09-11
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
CAG36476207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G364760Medicaid
CAG36476Medicare ID - Type Unspecified
E91286Medicare UPIN