Provider Demographics
NPI:1336349992
Name:H. MOAYERI, M.D.,INC.
Entity Type:Organization
Organization Name:H. MOAYERI, M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HOUSHANG
Authorized Official - Middle Name:
Authorized Official - Last Name:MOAYERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-842-7779
Mailing Address - Street 1:17822 BEACH BLVD
Mailing Address - Street 2:SUITE 343
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7101
Mailing Address - Country:US
Mailing Address - Phone:714-842-7779
Mailing Address - Fax:714-847-9334
Practice Address - Street 1:17822 BEACH BLVD
Practice Address - Street 2:SUITE 343
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7101
Practice Address - Country:US
Practice Address - Phone:714-842-7779
Practice Address - Fax:714-847-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37168207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28321Medicare UPIN
CAA37168Medicare PIN