Provider Demographics
NPI:1205802089
Name:MESHKINPOUR, AZIN (MD, MPH)
Entity type:Individual
Prefix:
First Name:AZIN
Middle Name:
Last Name:MESHKINPOUR
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24432 MUIRLANDS BLVD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3939
Mailing Address - Country:US
Mailing Address - Phone:949-770-8115
Mailing Address - Fax:949-770-2017
Practice Address - Street 1:24432 MUIRLANDS BLVD
Practice Address - Street 2:SUITE 219
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3939
Practice Address - Country:US
Practice Address - Phone:949-770-8115
Practice Address - Fax:949-770-2017
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75894207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA75894AMedicare PIN
CAH48193Medicare UPIN