Provider Demographics
NPI:1356414841
Name:IMPERIAL ANESTHESIA MEDICAL GROUP
Entity type:Organization
Organization Name:IMPERIAL ANESTHESIA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HIRSCHBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-748-0332
Mailing Address - Street 1:PO BOX 2757
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92859-0757
Mailing Address - Country:US
Mailing Address - Phone:714-748-0332
Mailing Address - Fax:714-748-0547
Practice Address - Street 1:101 E VALENCIA MESA DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3809
Practice Address - Country:US
Practice Address - Phone:714-871-3280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW145Medicare ID - Type Unspecified