Provider Demographics
NPI:1245443365
Name:SHIR A. MISKINYAR, MD, A PROFESSIONAL ORGANIZATION
Entity type:Organization
Organization Name:SHIR A. MISKINYAR, MD, A PROFESSIONAL ORGANIZATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIR
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:MISKINYAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-481-1685
Mailing Address - Street 1:817 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3624
Mailing Address - Country:US
Mailing Address - Phone:714-481-1685
Mailing Address - Fax:714-481-1687
Practice Address - Street 1:817 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3624
Practice Address - Country:US
Practice Address - Phone:714-481-1685
Practice Address - Fax:714-481-1687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA500802086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty