Provider Demographics
NPI:1134452725
Name:ARDALAN BABAKNIA M D PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ARDALAN BABAKNIA M D PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARDALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BABAKNIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-753-8844
Mailing Address - Street 1:15775 LAGUNA CANYON RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3189
Mailing Address - Country:US
Mailing Address - Phone:949-753-8844
Mailing Address - Fax:949-753-0181
Practice Address - Street 1:15775 LAGUNA CANYON RD
Practice Address - Street 2:SUITE 240
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3189
Practice Address - Country:US
Practice Address - Phone:949-753-8844
Practice Address - Fax:949-753-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00036607OtherCITY BUSINESS LICENSE
CAA44193OtherSTATE LICENSE
CAA44193OtherSTATE LICENSE